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PubMed1999

Glycemic control in diabetic American Indians. Longitudinal data from the Strong Heart Study.

OBJECTIVE: To describe glycemic control and identify correlates of elevated HbA1c levels in diabetic American Indians participating in the Strong Heart Study, which is a longitudinal study of cardiovascular disease in American Indians in Arizona, Oklahoma, South Dakota, and North Dakota. RESEARCH DESIGN AND METHODS: This analysis is based on data from the baseline (1989-1992) and first follow-up (1994-1995) examinations of the Strong Heart Study. The 1,581 diabetic participants included in this analysis were aged 45-74 years at baseline, were diagnosed with diabetes before and at baseline, and had their HbA1c levels measured at follow-up. HbA1c was used as the index of glycemic control. Characteristics that may affect glycemic control were evaluated for cross-sectional and longitudinal relationships by analysis of covariance and multiple regression. RESULTS: There was no significant difference between median HbA1c at baseline (8.4%) and at follow-up (8.5%). Sex, age (inversely), and insulin and oral hypoglycemic agent therapy were significantly related to HbA1c levels in both the cross-sectional and longitudinal analyses. Current smoking, prior use of alcohol, and duration of diabetes were significant only for the cross-sectional data. Baseline HbA1c significantly and positively predicted HbA1c levels at follow-up. Comparison of HbA1c by therapy type shows that insulin therapy produced a significant decrease in HbA1c between the baseline and follow-up examinations. CONCLUSIONS: Glycemic control was poor among diabetic American Indians participating in the Strong Heart Study. Women, patients taking insulin or oral hypoglycemic agents, and younger individuals had the worst control of all the participants. Baseline HbA1c, and weight loss predicted worsening of control, whereas insulin therapy predicted improvement in control. Additional therapies and/or approaches are needed to improve glycemic control in this population.

Administration, Oral↗
PubMed2000

Effects of obesity and body fat distribution on lipids and lipoproteins in nondiabetic American Indians: The Strong Heart Study.

OBJECTIVES: To examine the relationship between obesity and lipoprotein profiles and compare the effects of total obesity and central adiposity on lipids/lipoproteins in American Indians. RESEARCH METHODS AND PROCEDURES: Participants were 773 nondiabetic American Indian women and 739 men aged 45 to 74 years participating in the Strong Heart Study. Total obesity was estimated using body mass index (BMI). Central obesity was measured as waist circumference. Lipoprotein measures included triglycerides, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, apolipoprotein AI (apoAI), and apolipoprotein B (apoB). Partial and canonical correlation analyses were used to examine the associations between obesity and lipids/ lipoproteins. RESULTS: Women were more obese than men in Arizona (median BMI 32.1 vs. 29.2 kg/m2) and South Dakota and North Dakota (28.3 vs. 28.0 kg/m2), but there was no sex difference in waist circumference. Men had higher apoB and lower apoAI levels than did women. In women, when adjusted for center, gender, and age, BMI was significantly related to HDL cholesterol (r = -0.24, p < 0.001). There was a significant but weak relation with apoAI (r = -0.14, p < 0.001). Waist circumference was positively related to triglycerides (r = 0.14, p < 0.001) and negatively related to HDL cholesterol (r = -0.23, p < 0.001) and apoAI (r = -0.13, p < 0.001). In men, BMI was positively correlated with triglycerides (r = 0.30, p < 0.001) and negatively correlated with HDL cholesterol (r = -0.35, p < 0.001) and apoAI (r = -0.23, p < 0.001). Triglycerides increased with waist circumference (r = 0.30, p < 0.001) and HDL cholesterol decreased with waist circumference (r = -0.36, p < 0.001). In both women and men there was an inverted U-shaped relationship between obesity and waist with LDL cholesterol and apoB. In canonical correlation analysis, waist circumference received a greater weight (0.86) than did BMI (0.17) in women. However, the canonical weights were similar for waist (0.46) and BMI (0.56) in men. Only HDL cholesterol (-1.02) carried greater weight in women, whereas in men, triglycerides (0.50), and HDL cholesterol (-0.64) carried a large amount of weight. All the correlation coefficients between BMI, waist circumference, and the first canonical variable of lipids/lipoproteins or between the individual lipid/lipoprotein variables and the first canonical variable of obesity were smaller in women than in men. Triglycerides and HDL cholesterol showed clinically meaningful changes with BMI and waist circumference in men. All lipid/lipoprotein changes in women in relation to BMI and waist circumference were minimal. DISCUSSION: The main lipoprotein abnormality related to obesity in American Indians was decreased HDL cholesterol, especially in men. Central adiposity was more associated with abnormal lipid/lipoprotein profiles than general obesity in women; both were equally important in men.

Adipose Tissue↗
PubMed1990

Biomedical conflicts in the heartland. A systemwide ethics committee serves rural facilities.

Big-city medical research centers are not the only institutions facing ethical dilemmas. Bioethical conflicts occur regardless of community location or size. The Presentation Health Care System, Sioux Falls, SD, established a systemwide ethics committee. It owns, leases, or manages 15 rural institutions in four North Central states: South Dakota, North Dakota, Montana, and Minnesota. Of these facilities, 10 are hospitals and 5 are nursing homes. Most are located in small communities stretched along 1,100 interstate miles. The Presentation system began organizing its ethics committee in spring 1985. The ethics committee was to provide educational opportunities for its members, as well as for local facilities. These opportunities were to include subscriptions to appropriate publications, meetings with guest speakers, videos, and group "brainstorming" sessions. An annual ethics conference would provide community education and address the ethical issues confronting affiliates. Organizers scheduled a planning session at a systemwide leadership conference and invited anyone interested to attend. Eventually, 23 representatives of system affiliates were selected as members of the committee. The group meets twice a year. Since 1985, the committee has been holding ethics conferences on a regular basis.

Bioethics↗
PubMed2006

Mysterious outbreaks of gastrointestinal illness associated with burritos supplied through school lunch programs.

From October 1997 through March 1998, three outbreaks of gastrointestinal illness among school children were linked to company A burritos. In September 1998, a similar outbreak occurred in three North Dakota schools following lunches that included company B burritos. We conducted an investigation to determine the source of the North Dakota outbreak, identify other similar outbreaks, characterize the illness, and gather evidence about the cause. The investigation included epidemiologic analyses, environmental investigation, and laboratory analyses. In North Dakota, a case was defined as nausea, headache, abdominal cramps, vomiting, or diarrhea after lunch on 16 September 1998. Case definitions varied in the other states. In North Dakota, 504 students and staff met the case definition; predominant symptoms were nausea (72%), headache (68%), abdominal cramps (54%), vomiting (24%), and diarrhea (16%). The median incubation period was 35 min and median duration of illness was 6 h. Eating burritos was significantly associated with illness (odds ratio, 2.6; 95% confidence interval, 1.6 to 4.2). We identified 16 outbreaks that occurred in seven states from October 1997 through October 1998, affecting more than 1,900 people who ate burritos from two unrelated companies. All tortillas were made with wheat flour, but the fillings differed, suggesting that tortillas contained the etiologic agent. Results of plant inspections, tracebacks, and laboratory investigations were unrevealing. More than two million pounds of burritos were recalled or held from distribution. The short incubation period, symptoms, and laboratory data suggest that these outbreaks were caused by an undetected toxin or an agent not previously associated with this clinical syndrome. Mass psychogenic illness is an unlikely explanation because of the large number of sites where outbreaks occurred over a short period, the similarity of symptoms, the common food item, the lack of publicity, and the link to only two companies. A network of laboratories that can rapidly identify known and screen for unknown agents in food is a critical part of protecting the food supply against natural and intentional contamination.

Child↗
PubMed1991

Effects of an expanded medical curriculum on the number of graduates practicing in a rural state.

In 1973 the University of North Dakota School of Medicine (UNDSM), following the national trend toward four-year medical programs, expanded its previous two-year medical school curriculum to include all four years of medical education. It was hoped that this change, along with a renewed emphasis on primary care-oriented residency training within the state, would encourage medical students to establish practices within the state. In 1985 the UNDSM's Center for Rural Health mailed questionnaires to the 2,230 living graduates of the UNDSM to document a variety of their personal and practice characteristics. Based on the responses to the 924 completed questionnaires, the authors found that (1) the students from rural North Dakota were more likely than were urban students to practice in rural areas of the state, as were the students with primary care specialty training; and (2) the alumni completing residencies in North Dakota following the curriculum expansion (1976-1985) were more than twice as likely to establish practices in North Dakota. It was concluded that recruiting medical students (preferably in-state "natives") from rural areas, training them in primary care specialty areas, and enabling them to remain in North Dakota for the duration of their medical training (including residency training) combined to exert a considerable "retaining" effect on the UNDSM alumni.

Curriculum↗
PubMed1991

Data collection in the Great Plains Genetics Service Network: using limited funds to collect data from centers with varying resources.

The Data Committee of the Great Plains Genetics Service Network (GPGSN) coordinates the collection of data relating to delivery of genetic services in eight states. These states are Iowa, Missouri, Arkansas, Oklahoma, Kansas, Nebraska, South Dakota and North Dakota. The funds allocated to this project by the GPGSN are limited. The distance between genetics service sites is great and the population density in the regions being served is low. The local resources available to the genetics services sites participating in data collection vary from robust to "bare-bones". The approach to solving the problem involved the following. First the committee the data items to be collected were identified and defined. Second, a standard format for transmitting the data to the GPGSN regional coordinating center in Iowa City was developed. Third, the services sites and their resources for collecting data were identified. Fourth, resources were allocated to different sites in a manner that seemed most able to help that center to contribute data to the regional center. Fifth, data were aggregated at the regional center and aggregated data reports were returned to collecting sites. Finally, items were modified in response to the feedback received from the genetics services sites. Although the philosophy is that data collection should be a by-product of providing quality genetic services, the region recognizes that service sites will need help to conform with regional standards. Therefore the region encourages each service site to develop its own method to collect data, and provides assistance to it in getting the data into the regional transmission format.(ABSTRACT TRUNCATED AT 250 WORDS)

Data Collection↗
PubMedDate not supplied

Changes in longevity by state.

The latest state data just released from the National Center for Health Statistics reveal that men and women living in Hawaii can expect, on the average, to live longer than those residing in any other state. During 1989-91 expectation of life at birth for all residents of the United States was 71.8 for boys and 78.8 for girls. In Hawaii, however, average future lifetime for newborn boys was 75.4 years and 81.3 for girls. For infant boys, the states that followed in rank order were Utah, Minnesota and North Dakota. Among baby girls, the leading states were North Dakota, Minnesota, South Dakota and Iowa. On the other hand, the District of Columbia, on average, experienced the least favorable longevity. For each sex, geographic longevity disparities diminish with advance in age. Yet, for almost the entire age range, Hawaii still remained the state with the best longevity outlook. Among the next most desirable areas, the rankings shifted positions, somewhat. Even so, North Dakota, Minnesota and Utah usually recorded the highest state life expectancies. These same states also ranked best during 1979-81. Between 1979-81 and 1989-91, on a state-by-state basis, life expectancy gains generally were larger among men than among women.

Adolescent↗
PubMed2003

Dietary composition and weight change among low-income preschool children.

OBJECTIVE: To examine the relation between dietary composition and weight change among children. We tested several hypotheses considering intake of nutrients (total fat and fiber) and predefined food groups (breads and grains, "fat foods," fruits, and vegetables) used in the North Dakota Special Supplemental Nutrition Program for Women, Infants, and Children (WIC Program). DESIGN: Prospective study. Subjects We collected dietary, anthropometric, and sociodemographic data from 1379 children aged 2 to 5 years participating in the North Dakota WIC Program on 2 visits ranging from 6 to 12 months apart. Main Outcome Measure Annual change in weight. RESULTS: In multiple regression analyses, no significant relations were found between total intake of fat, fiber, fruits, or vegetables and weight change. There was a 0.16-kg lower weight change per year (95% confidence interval [CI], -0.20 to -0.12 kg; P<.01) with each additional daily serving of breads and grains, and a 0.05-kg greater weight change per year (95% CI, 0.1-0.09 kg; P<.05) for each additional serving of fat foods in a model adjusting for sex, age, baseline weight, change in height, and sociodemographic variables. CONCLUSIONS: Intake of North Dakota WIC Program-defined fat foods, but not dietary fat per se, significantly predicted weight gain, whereas intake of North Dakota WIC Program-defined breads and grains, but not fiber per se, significantly predicted weight loss in preschool children.

Body Weight↗
PubMed1997

Unity and power: lessons from baccalaureate entry.

Education for nurses has been a contentious issue within and outside of the nursing profession since the American Nurses Association's 1965 support of the baccalaureate degree in nursing as basic educational criteria for the professional nurse (American Nurses Association, 1965). For 10 years, North Dakota has remained the only state to have achieved this educational goal, and North Dakota nurses have been able to defend this position against repeated challenges within the state since 1985. This article places nursing education within the context of the evolving, sweeping changes that are impacting all providers in the health care arena. The authors explain how and why North Dakota nurses were able to accomplish the standardization of nursing education for two levels of nurses: registered nurses and licensed practical nurses. The article describes the positive outcomes for nurses and clients that have occurred over the past 10 years.

American Nurses' Association↗
PubMed2000

Benchmarking in health-system pharmacy: experience at MeritCare Medical Center.

The experience of MeritCare Medical Center (MMC) with the Benchmarking Program coordinated by The Clinical Pharmacokinetics Laboratory at Millard Fillmore Hospital is described. MMC is a community-based teaching institution in Fargo, North Dakota, that serves patients in North Dakota, South Dakota, and Minnesota. MeritCare began participating in the Benchmarking Program in 1997. Data from the individual hospital report raised concern about the high cost of antimicrobials at MMC relative to peer-group institutions. The staff conducted an evaluation of antimicrobial prophylaxis for noncardiovascular surgery, concluded that cefazolin use was suboptimal, and attempted to encourage more cost-effective utilization. MMC's participation in the Benchmarking Program also prompted more appropriate use of various other antimicrobial agents, including i.v. and oral ciprofloxacin. An i.v.-to-oral switching program was begun for various agents. Preliminary analysis after 15 months demonstrated direct cost savings for drug acquisition of $60,000 to $80,000 per year and a reduced length of stay. Initiatives undertaken by MeritCare on the basis of data obtained through the Benchmarking Program resulted in substantial estimated savings in drug acquisition costs.

Anti-Bacterial Agents↗
PubMed1985

A validation of two motion sensors in the prediction of child and adult physical activity levels.

The authors sought to assess the reliability and validity of two motion activity sensors in the prediction of observed physical activity levels in adults and children by means of two studies at North Dakota State University in Fargo, North Dakota. In study 1, 50 adults were observed in fall 1984 for one hour of recreational activity while they simultaneously wore two motion sensors: an activity counter (i.e., LSI Moving Activity Monitor (GMM Electronics Inc., Verona, PA)) and an electronic accelerometer (i.e., Caltrac Personal Activity Computer (Hemokinetics, Inc., Vienna, VA)). The results indicated that both the activity counter (r = 0.65) and the accelerometer (r = 0.69) strongly correlated to observed physical activity levels. The two motion sensors also were highly correlated to each other (r = 0.83). A correlation of self-reports of time spent in various types of physical activity to observed physical activity ranged from 0.21 to 0.88 (mean = 0.60). Study 2 evaluated these same two sensors in winter 1984 in 30 preschool children observed in a freeplay situation. Results of this study indicated very modest relationships between observed physical activity levels and accelerometer readings (r = 0.35) and activity counter readings (r = 0.40). The two motion sensors intercorrelated at very modest levels (r = 0.42). The results indicate that while both motion sensors closely corresponded to observed levels of physical activity in adults, neither sensor correlated substantively to observed levels of physical activity in children. Implications for validating and utilizing these sensors in epidemiologic research are discussed.

Age Factors↗
PubMed2003

Distribution and ecology of meningeal worm, Parelaphostrongylus tenuis (Nematoda), in northcentral North America.

Meningeal worm (Parelaphostrongylus tenuis), a common nematode parasite in white-tailed deer (Odocoileus virginianus) and pathogenic for several species of ungulates in eastern North America, is not known to occur in the west. Heads of 1,902 white-tailed deer were examined for adult meningeal worm to determine geographic distribution of the parasite in Saskatchewan and Manitoba (Canada) and North Dakota (USA). Finding the parasite in a deer in eastern Saskatchewan near the Manitoba border established the current northern and western limits in Canada. Prevalence of infection was < 1, 18.6, and 8.2% in Saskatchewan, Manitoba, and North Dakota, respectively. Infected deer occurred throughout southern Manitoba and eastern North Dakota. Distribution appears to have changed little since the last published survey for P. tenuis in the region in 1972. We examined precipitation, temperature, deer density, and forest cover as likely correlates to prevalence and distribution of P. tenuis. Deer management units used for hunting purposes were the scale of analysis in the three jurisdictions. Presence of P. tenuis was positively correlated with precipitation during frost-free periods and deer density, and it was negatively correlated with winter and spring temperatures. Landscapes with > 25 and < 75% forest cover were most likely to have infected deer. Low rainfall and low density of white-tailed deer likely influence the westernmost limit of P. tenuis.

Animals↗
PubMed2005

Factors associated with incidence of "inappropriate" ambulance transport in rural areas in cases of moderate to severe head injury in children.

CONTEXT: Ambulance transport of pediatric trauma patients to designated trauma centers in cases of moderate and severe injury is not always performed, which has been shown to result in poor treatment outcomes. Determination of factors involved in inappropriate patient transport, especially in rural areas, remains an important avenue of research. PURPOSE: To identify factors involved in ambulance transport of pediatric patients sustaining moderate-to-severe head injury to nondesignated trauma centers in rural North Dakota. METHOD: Emergency medical service ambulance records for North Dakota from 1995 to 2000 were used. One hundred fifty-six cases of pediatric head injuries with Glasgow Coma Scale scores < or =12 and transported by rural ambulance squads were selected. A logistic regression analysis was conducted to identify a set of significant predictors of cases of inappropriate deliveries to acute care facilities with no trauma-center designation of any level (II-V). RESULTS: Greater distance (mean = 19.96 miles) to the nearest trauma center and shorter distance traveled by the ambulance squad to the receiving facility (mean = 19.07 miles) corresponded to higher probabilities of mistriage, especially when a child was Native American (16 times more likely) and the transportation was conducted in the winter (9 times more likely). CONCLUSIONS: Timely delivery of pediatric trauma patients to designated trauma centers is encumbered in the winter, particularly in Native American communities, because of the greater traveling distances, which could be counteracted by better mobilization of available resources aimed at administration of optimal trauma care.

Adolescent↗
PubMed1991

Barriers to the retention of registered and licensed practical nurses in small rural hospitals.

The availability of nursing resources is one of the most critical issues facing health care organizations in the country. The study investigated the potential factors that relate to the desire of registered nurses (RNs) and licensed practical nurses (LPNs) to continue practicing in rural hospitals of North Dakota. All RNs and LPNs who worked in North Dakota hospitals with fewer than 100 beds (490 hospitals) were mailed survey questionnaires. Approximately eight weeks later, responses were received from 291 respondents for an overall return rate of 59 percent. Correlational analyses were used to examine the subjects' responses. A moderate relationship was found among the work-related variables. Overall job satisfaction and performance constraints were the only variables to make significant contributions to the prediction of turnover intention for both RNs and LPNs. Overall job satisfaction accounted for the largest percentage of the variance (R2 = 0.42 and R2 = 0.44) for RNs and LPNs, respectively. Satisfaction with promotion was the only work-related variable to make a significant contribution to the prediction of turnover intention for RNs (R2 = 0.23). Performance constraints, role ambiguity, and shift worked were the only work-related variables contributing to the prediction of turnover for LPNs. These results are discussed in terms of their implications for the management of RNs and LPNs in rural hospitals. Clinical ladders for promotions, the identification of potential performance constraints, and supervisory training are suggested as target areas in which rural hospitals might focus attention for managing turnover in RNs and LPNs.

Attitude of Health Personnel↗
PubMed2002

Efficacy of a 1% lambdacyhalothrin cattle Pour-on (Saber) against sucking and biting lice infesting beef cattle.

Four studies were conducted to determine the efficacy of a 1% lambdacyhalothrin pour-on (Saber Pour-on, Schering-Plough Animal Health) for control of sucking lice (Linognathus vituli, Haematopinus eurysternus, Solenopotes capillatus) and biting lice (Damalinia bovis) on beef cattle. Seventy-four mixed-breed cattle naturally infested with one or more species of lice at locations in Wisconsin, Nebraska, Oklahoma, and North Dakota were included in the study. Pretreatment lice samples were taken and identified by genus with the exception that sucking lice were not identified by genus at the North Dakota site. In January or February, half of the cattle at each location received a single application of 1% lambdacyhalothrin pour-on at 10 ml per head for cattle weighing less than 273 kg (600 lb) or 15 ml per head for cattle weighing 273 kg or more. The other cattle at each site served as untreated controls. Lice on designated body areas were counted 2, 4, 6, and 8 weeks after treatment, and the sum of all lice observed on each counting area was reported for each animal. The collective efficacy 6 weeks after treatment against three species of sucking lice (L. vituli, H. eurysternus, S. capillatus) was 88.4% at the Wisconsin site, 92.0% at the North Dakota site, and 100% at the Nebraska and Oklahoma sites. The 1% lambdacyhalothrin pour-on eliminated all biting lice within 2 weeks after treatment, and no biting lice were detected 8 weeks after treatment. A single treatment of 1% lambdacyhalothrin pour-on administered when lice populations were highest (January or February) provided effective season-long control of both biting and sucking lice on cattle.

Administration, Cutaneous↗
PubMed2004

Microbial loads, mycotoxins, and quality of durum wheat from the 2001 harvest of the northern plains region of the United States.

The 2001 durum wheat crop grown in the Northern Plains was surveyed for microbial loads, mycotoxins, and quality. Correlations among these factors were identified. Effects of cleaning, milling, and pasta processing on microbial loads and deoxynivalenol (DON) concentrations were determined. Aerobic plate counts (APCs), mold and yeast counts (MYCs), internal mold infection (IMI), and internal Fusarium infection (IFI) were lowest in grain samples from Montana and highest in grain from northeastern North Dakota. DON and 15-acetyldeoxynivalenol (15-ADON) were not detected in samples from Montana. Nivalenol was not detected in any samples. DON in North Dakota samples ranged from none detected to 23 micrograms/g. 15-ADON was detected in a few North Dakota samples, with a maximum of 0.8 microgram/g. DON positively correlated with APCs, MYCs, IFI, damaged kernels, total defects, U.S. grade number, and tombstone kernel content and negatively correlated with test weight, vitreous kernel content, and kernel weight. APCs, MYCs, and DON concentrations were lower in semolina than whole grain. Processing semolina into spaghetti did not change DON concentrations. APCs for spaghetti were reduced 2.2 to 4.1 logs from those for semolina, whereas MYCs were reduced 0.1 to 1.7 log. Some APCs in durum flour and semolina were higher than certain industry specifications would allow, although other factors were acceptable. However, microbial loads in the spaghetti were all within specifications found in the available literature.

Consumer Product Safety↗
PubMed1989

"Making sense" about diabetes: Dakota narratives of illness.

Diabetes, as it has increasingly affected Dakota (Sioux) in a North Dakota community, is deliberated upon by patients in commentaries that range beyond the more familiar biomedical "boundaries" of a given health condition. These commentaries--or "narrative reconstructions"--following Williams and Wood's (1986) considerations of patients "making sense" of illness and the disruption it may cause, touch upon larger concerns of Dakota regarding culture history and identity. While individuals' interpretations regarding etiology, illness experience, and efficacy of treatments vary, diabetes emerges as a symbol that conveys meaning at many levels. That diabetes treatment may impinge on customary foodways makes imagery of diabetes perhaps more salient. Health workers, trained within the "culture of biomedicine" (Hagey 1984), may learn to recognize key elements in such narratives for cooperative efforts in diabetes education and treatment.

Attitude to Health↗
PubMed1980

A political action success story.

When the insurance commissioner of North Dakota put on the ballot a proposal to place the costs of all health services under state regulation and control, the North Dakota Hospital Association (NDHA) set in motion an all-out campaign to defeat the measure. The president of the association describes the NDHA's successful grass-roots lobbying effort.

Community Participation↗