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PURPOSE: One-quarter of the United States of America's population lives in rural areas, but only 12.3% of physicians live and work in rural areas. Nearly one-quarter of the counties in Iowa boast a patient-to-physician ratio of 3000:1. The number of rural surgeons is decreasing, and current residency programs may not optimally train graduates for the spectrum of surgical practice seen in rural areas. The scope of surgical practice differs between rural and non-rural surgeons, and in this study, we identified the types of surgery performed by 6 rural Iowa surgeons and compared the practices of rural and non-rural surgeons in Iowa. METHODS: Data from personal interviews and questionnaires with rural Iowa general surgeons and rural Iowa hospital administrators and results from the Iowa General Surgeon Practice Opportunity Survey were analyzed retrospectively. RESULTS: In 1995, 31 general surgeons were recruiting a general surgeon partner, of which 25 were in rural Iowa communities. Eighteen rural Iowa Hospital administrators were actively recruiting a general surgeon during the same time period. In September 2000, many of these positions remained unfilled. A total of 4963 surgical procedures were performed by 6 rural Iowa general surgeons in Iowa in 1995. Endoscopic, alimentary, and obstetrics and gynecologic procedures were the most frequently performed. Excluding endoscopy, 26% of all procedures performed were procedures not among the Accreditation Council of Graduate Medial Education (ACGME) list of requirements for graduating surgical residents. CONCLUSIONS: Rural Iowa general surgeons perform a large volume of surgery and more subspecialty procedures than do their non-rural counterparts. Surgical residency programs need to more adequately train residents interested in rural general surgery in an effort to increase the pool of graduating surgical residents trained to deal with the scope of procedures a rural practice offers. This will help reduce the shortage of rural general surgeons in the United States of America.
Hb Iowa is a rare hemoglobin (Hb) variant with a Gly --> Ala substitution at position 119 of beta-globin. It was previously reported only in an African American infant who was also heterozygous for Hb S [beta6(A3)Glu --> Val] and her mother (Hb A/Iowa). Here we describe the second report of Hb Iowa, the first in conjunction with Hb C [beta6(A3)Glu --> Lys]. The patient was an African American girl, originally diagnosed as homozygous Hb C during neonatal screening. When seen in our clinic, hematological data for both the child and her mother (Hb C trait) indicated mild anemia with slightly low mean corpuscular volume (MCV) but normal red blood cell (RBC) count. Analysis of blood from the child by capillary isoelectric focusing (cIEF) identified Hb C and an unknown Hb variant with an isoelectric point (pI) intermediate to that of Hbs F and A. The unknown variant was identified as Hb Iowa by DNA sequence analysis of the beta-globin gene (GGC --> GCC). Both reported cases of Hb Iowa indicated that there are no abnormal hematological manifestations associated with this rare Hb variant. In both cases, however, Hb Iowa was mistaken for Hb F during routine neonatal screening by high performance liquid chromatography (HPLC) and/or gel IEF. Neonatal misidentification of Hb Iowa led to misdiagnosis of sickle cell disease and Hb C disease, respectively. In our patient, Hb Iowa was also misidentified as Hb A at 2 years of age by a commercial reference laboratory using cellulose acetate and citrate agar gel electrophoresis. This led to an incorrect diagnosis of Hb C trait. These results show that commonly used analytical methods can easily misidentify Hb Iowa as Hbs F or A in neonates, or older individuals, resulting in incorrect identification of the Hb phenotype. We conclude that the presence of Hb Iowa, or other variants with similar pIs, should be considered in cases where the results of follow-up testing conflict with neonatal diagnosis of sickle cell or Hb C disease, or where clinical presentation does not agree with diagnosis of either homozygous or heterozygous Hb S or Hb C.
Pesticides and fertilizers, as used in modern agriculture, contribute to the overall low-level contamination of groundwater sources. In order to determine the potential of pesticide and fertilizer mixtures to produce reproductive or developmental toxicity at concentrations up to 100 x the median level found in groundwater, we prepared and studied two mixtures of pesticides and a fertilizer (ammonium nitrate). One mixture containing aldicarb, atrazine, dibromochloropropane, 1,2-dichloropropane, ethylene dibromide, and simazine plus ammonium nitrate was considered to be a representative of groundwater contamination in California (CAL). The other, containing alachlor, atrazine, cyanazine, metolachlor, metribuzin, and ammonium nitrate, simulated groundwater contamination in Iowa (IOWA). Each mixture was administered in the drinking water of either Swiss CD-1 mice during a Reproductive Assessment by Continuous Breeding study or pregnant Sprague-Dawley rats (gd 6-20) at three dose levels (1x, 10x, and 100x) where 1x was the median concentration of each pesticide component as determined in the groundwater surveys in California or Iowa. Unlike conventional toxicology studies, the purpose of this study was to evaluate the health effects of realistic human concentrations. Thus, the testing concentrations are probably well below the maximally tolerated dose. Propylene glycol was used as the solubilizer for the pesticides in drinking water formulations in both studies. In the reproductive study, neither mixture caused any clinical signs of toxicity, changes in food or water consumption, or body weight in either F0 or F1 mice at doses up to 100x the median groundwater concentrations. There were no treatment-related effects on fertility or any measures of reproductive performance of either the F0 or the F1 generation mice exposed to either CAL or IOWA at up to 100x. Similarly, measures of spermatogenesis, epididymal sperm concentration, percentage motile sperm, percentage abnormal sperm, and testicular and epididymal histology were normal. In the developmental study, CAL- or IOWA-exposed females did not exhibit any significant treatment-related clinical signs of toxicity. No adverse effects of CAL or IOWA were observed for measures of embryo/fetal toxicity, including resorptions per litter, live litter size, or fetal body weight. CAL or IOWA did not cause an increased incidence of fetal malformations or variations. In summary, administration of these pesticide/fertilizer mixtures at levels up to 100-fold greater than the median concentrations in groundwater supplies in California or Iowa did not cause any detectable reproductive (mice), general, or developmental toxicity (rats).
OBJECTIVE: To estimate the average survival effects of breast conserving surgery plus irradiation relative to mastectomy for marginal stage II breast cancer patients in Iowa from 1989-1994. DATA SOURCES/DATA SETTING: Secondary linked Iowa SEER Cancer Registry--Iowa Hospital Association discharge abstract data for women in Iowa with stage II breast cancer from 1989-1994. STUDY DESIGN: Observational instrumental variables (IV) analysis. DATA COLLECTION/EXTRACTION METHODS: Women with stage II breast cancer from the Iowa SEER Cancer Registry 1989-1994 who received all of their inpatient care in Iowa were linked with their respective hospital discharge abstracts. PRINCIPAL FINDINGS: Breast conserving surgery plus irradiation decreased survival relative to mastectomy for marginal stage II breast cancer patients in Iowa during the early 1990s. In this study marginal patients were those whose surgery choices were affected by differences in area treatment rates and access to radiation facilities. CONCLUSIONS: If marginal patients are representative of patients whose treatment choices would be affected by changes in treatment rates, an increase in the breast conserving surgery plus irradiation rate for stage II early stage breast cancer patients would have decreased survival in Iowa during the early 1990s. Further research with newer data and broader samples is needed to make more current and specific assessments.
Strong traditions of basic research, clinical innovation, teaching and integrating science and evaluation of outcomes into clinical practice have characterized University of Iowa orthopaedics for ninety years. These traditions were brought to Iowa City from Vienna when Iowa City was a town of fewer than 10,000 people in a sparcely populated rural state. In the last third of the 19th century, surgeons at the University of Vienna, led by Theodore Billroth (1829-1894), helped transform the practice of surgery. They developed new more effective procedures, analyzed the results of their operations, promoted the emergence and growth of surgical specialties and sought understanding of tissue structure, physiology and pathophysiology. Their efforts made Vienna one of the world's most respected centers for operative treatment, basic and clinical research and surgical education. Two individuals who followed Billroth, Eduard Albert (1841-1900) and Adolf Lorenz (1854-1946) focussed their research and clinical practice on orthopaedics. Their successes in the study and treatment of musculoskeletal disorders led one of their students, Arthur Steindler (1878-1959), a 1902 graduate of the Vienna Medical School, to pursue a career in orthopaedics. Following medical school, he worked in Lorenz's orthopaedic clinic until 1907 when he joined John Ridlon (1852-1936) at the Chicago Home for Crippled Children. In 1910, Steindler became Professor of Orthopaedics at the Drake Medical School in Des Moines, Iowa, and, in 1913, John G. Bowman, the President of the University of Iowa, recruited him to establish an orthopaedic clinical and academic program in Iowa City. For the next third of a century he guided the development of the University of Iowa Orthopaedics Department, helped establish the fields of orthopaedic biomechanics and kinesiology and tirelessly stressed the importance of physiology, pathology and assessment of the outcomes of operations. From the legacy of Billroth, Albert and Lorenz, Arthur Steindler created an internationally recognized center for orthopaedic care, research and teaching in Iowa City.
BACKGROUND: Farmers have been previously reported to have higher rates of depression and suicide compared to other occupations. Comparisons of depressive symptoms and risk factors for states should increase understanding of depression in farmers. METHODS: Representative samples of 385 Iowa and 470 Colorado male principal farm operators in the respective state Farm Family Health and Hazard Surveillance projects were evaluated for depressive symptoms by using the CES-D scale. Risk factors were determined by using weighted multiple logistic regression analyses. RESULTS: Iowa farmers were 1.74 times (P < 0.05) more likely to have had depressive symptoms than Colorado farmers. Being unmarried (odds ratio=3.46), having negative life events within the past year [legal problems (4.67), substantial income decline (2.71), loss of something of sentimental value (3.20)], and lower perceived general health status were risk factors (P < 0.05) for depressive symptoms for male Iowa and Colorado farmers. Higher levels of most risk factors for Iowa farmers, almost twice the frequency of substantial income decline, accounted for the majority of the difference in depressive symptoms between Iowa (12.2%) and Colorado (7.4%). CONCLUSIONS: Although Iowa farmers had 1.74 times higher level of depression symptoms than Colorado farmers, this difference was not significant after adjusting for the higher levels of most risk factors for Iowa farmers.
A survey of Iowa farmers was conducted to assess the farmers' perceptions and beliefs regarding auger safety and how these perceptions are put into practice. A questionnaire was designed to obtain information on the following auger-related topics: recognition of safe practices and appropriate shielding, personal practices and behaviors, risk perception, and personal beliefs. A random sample of 400 Iowa farmers (arrayed by county) was selected to be representative of Iowa farms. The response to the mailed survey was 23%. Some returned surveys were eliminated because the respondent was retired or did not own/operate augers, resulting in 57 usable questionnaires. Survey responses indicate that the majority of Iowa farmers who participated in this study can correctly identify appropriate shielding for auger intake that meet or exceed ASAE standards. Survey responses suggest that it is common practice in Iowa for youth (age 13 to 19) to operate augers. Iowa farmers in this study perceive the most important contributing factors to auger-related injuries to be operating an auger without shielding, failure to pay attention on the job, moving augers in a raised position, and using hand or feet to redirect the flow of grain. Survey results also indicate that carelessness is perceived to be the leading cause of auger-related injuries, and that auger related injuries can be avoided by having respect for the equipment, being careful, and using common sense. The results also show that the Iowa farmers who participated in this study commonly perform auger-related practices (e.g., moving an auger in a raised position) that they identify as being unsafe.
The prevalence of coronary heart disease (CHD) risk factors in law enforcement personnel compared to that in the general population was studied by determining the predicted 10-year risk for developing CHD (CHD10, expressed as %) in subjects from the Iowa Department of Public Safety and comparing it to the average CHD10 for similarly aged subjects in the Framingham Heart Study cohort. The Iowa data included measures on 388 men from 30 to 64 years old, 246 of whom were measured in 1980-1981 and again in 1992-1993. The CHD10 came from an algorithm developed using the Framingham data; it included measures of age, gender, cholesterol, HDL-C, systolic blood pressure, smoking habit, glucose level, and left ventricular hypertrophy (ECG criteria). For this group, average CHD10 was reported by age in five-year increments [Circulation 83:356, 1991]. The Iowa subjects (n = 388) did not show a statistically significant difference in CHD10 from the reference population (8.9% versus 7.9%). The change with age was very similar in the two groups: for Iowa (n = 388) the estimate was CHD10 = -16.5 + .59 (age); for Framingham it was CHD10 = -17.5 + .60 (age). The change in individual risk factors with time was also similar in both groups; the per year change in CHD10 in the Iowa subjects, which was measured twice (n = 246, 0.63%), did not differ statistically from the 0.60% change predicted by the Framingham model. These results suggest that, for the risk factors considered here, the 10-year probability of developing CHD among Iowa law enforcement personnel is similar to that found in the Framingham population.
BACKGROUND: HEV causes an enteric infectious disease endemic in developing areas with hot climate. A case of endogenous HEV infection has been reported in the US. Recently, HEV-like virus was isolated from swine in Iowa. Swine production is a major industry in Iowa with the potential for human exposure to swine in and around industrial and family farm operations. OBJECTIVE: The study objective was to determine whether individuals in Iowa are exposed to HEV. STUDY DESIGN: Anti-HEV antibody prevalence in four selected Iowa populations was determined. Sera were collected from 204 patients with non-A, non-B, non-C hepatitis (non-A-C); 87 staff members of the Department of Natural Resources (DRN); 332 volunteer blood donors in 1989; and 111 volunteer blood donors in 1998. All sera were tested for anti-human HEV IgM and IgG by ELISA with confirmation of positivity by a peptide neutralization test. RESULTS: Both the patients with non-A, non-B, non-C hepatitis (4.9%) and the healthy field workers from the Iowa DNR (5.7%) showed significantly higher prevalence of anti-HEV IgG antibodies compared to normal blood donor sera collected in 1998 (P < 0.05). CONCLUSIONS: Human HEV or a HEV-like agent circulates in the Iowa geographical area. At-risk human populations with occupational exposure to wild animals and environmental sources of domestic animal wastes or with unexplained hepatitis have increased seroprevalence of HEV antibodies.
This notice announces the Secretary's proposal to revise Iowa Health Service Area No. 1. The Governor of Iowa requested that Iowa Health Service Area No. 1, served by Iowa Health Systems Agency, be revised to include the Iowa counties of Harrison, Shelby, Pottawattamie, Mills, Montgomery, Adams, Fremont, Page, and Taylor. These nine counties had been included in Nebraska Health Service Area No. 3, served by the Health Planning Council of the Midlands, Inc. The nine counties are currently not included in any health service area or served by any health systems agency because the Governor of Nebraska requested and received a Section 1536 designation for his State. Such a designation precludes the Secretary from establishing any health service areas and designating any health systems agencies in a State. As a result, the designation agreement of the Health Planning Council of the Midlands, Inc., was not renewed at the end of its grant year, and the nine counties in Iowa are therefore not included in any health service area.
BACKGROUND: The purpose of this study was to to describe the practice of physical medicine and rehabilitation within Iowa from 2000-2005 by conducting a survey of the 30 practicing physical medicine and rehabilitation physicians in Iowa. RESULTS: Nine of 15 respondents completed medical school or residency training in midwest states. Physiatrists expressed numerous concerns including poor reimbursement, increasing malpractice costs, and difficulty recruiting physiatrists to Iowa. Iowa is ranked 49th in physical medicine and rehabilitation physicians per capita population. It also ranks 50th in Medicare payments per enrollee, yet is ranked fourth in the nation for percentage of citizens over the age of 65. CONCLUSIONS: Recruitment of physical medicine and rehabilitation physicians should be tailored toward resident physicians completing training programs from midwest states. Retention of Iowa physiatrists, due to Iowa's lack of a physical medicine and rehabilitation residency training program, low Medicare reimbursement, and high percentage of patients over the age of 65, may lead to a "perfect storm" public health crisis for Iowans regarding the availability of future physical medicine and rehabilitation services.
Tissue- and cell-specific attachment of mycoplasmas is a key aspect of the host-parasite relationship. In this study, monoclonal antibodies (MAbs) recognizing surface membrane polypeptides with molecular masses of 46 kD (p46) and 65 kD (p65), respectively, were examined in a microtiter cell attachment (agglutination) inhibition assay. MAbs MI3, MI6, and MI12 reacting with p65 polypeptide of Mycoplasma iowae inhibited attachment of the organisms to chicken lymphoma (DT 40) cells. One MAb (MI2) that reacted with p65 in immunoblots did not inhibit cell attachment, possibly because of the intrinsic native conformation of the epitope(s) in intact mycoplasmas as opposed to the linear state (sodium dodecyl sulfate denatured) in immunoblots. More pronounced M. iowae adherence inhibition was demonstrated by polyclonal turkey and mouse anti-M. iowae antisera compared with MAbs. Immunogold labelling followed by electron microscopy allowed us to localize the MAb-recognized epitopes on the membrane surface of M. iowae. On the basis of the cell attachment inhibition of M. iowae by specific MAbs (MI3, MI6, and MI12), we propose that the p65 polypeptide plays a role in cytadherence. The ability of polyclonal antisera to inhibit attachment of M. iowae more efficiently than the MAbs suggests that additional epitopes within p65 and/or other proteins are involved in cell attachment.
The purpose of this study is to develop cephalometric standards for North Mexican male and female adolescents. The subjects evaluated in the study included 36 North Mexican boys with a mean age of 12.8 years and 45 North Mexican girls with a mean age of 13.0 years. The Iowa sample included 20 boys and 15 girls of similar age who were participants in the longitudinal facial growth study at the University of Iowa. Basic descriptive statistics are presented on 26 cephalometric parameters arranged in five categories: skeletal angular relationships, skeletal linear relationships, dental angular relationships, dental linear relationships, and soft-tissue profile relationships. The general linear models procedure--analysis of variance--was used for comparisons between the two populations. F values were calculated for the overall group comparisons and indicated the presence of statistically significant differences between the four subgroups examined, namely, Iowa boys and girls and North Mexican boys and girls. Significant differences between boys and girls within each population were found in the skeletal linear parameters of both the anterior and posterior face heights. Furthermore, in the North Mexican population, the Holdaway soft-tissue angle was significantly larger in boys than in girls, indicating a more convex soft-tissue profile for boys at this age. When comparisons were made between the two populations, it was of interest to note the absence of any significant differences between the North Mexican and Iowa boys. But when the North Mexican girls were compared to the Iowa girls, the SNB and SNPog angles, as well as the ratio of posterior face heights, were significantly larger for the North Mexican girls.(ABSTRACT TRUNCATED AT 250 WORDS)