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Five persons contracted tick-borne relapsing fever after staying in a cabin in western Montana. Borrelia hermsii was isolated from the blood of two patients, and Ornithodoros hermsi ticks were collected from the cabin, the first demonstration of this bacterium and tick in Montana. Relapsing fever should be considered when patients who reside or have vacationed in western Montana exhibit a recurring febrile illness.
States that do not have a family practice residency program face problems in attracting residency trained family physicians. This article describes the development of a unique program in Montana utilizing a series of satellite programs under the direction of family physicians and a statewide coordinating office. These offer the resident a one- or two-month rotation during off-campus elective time in the second or third year of a family practice residency. The program offers the practicing physician a chance to participate in the training of residents and offers the resident an educational opportunity in rural medicine. It also exposes the resident to a Montana community and to practice in Montana. Survey evidence indicates that this type of program has a definite influence on a resident's choice of a practice location.
Congestive right ventricular heart failure of Montana cattle is characterized clinically by an accumulation of edematous fluid in the brisket region and ventral portions of the body but not of the legs. A well developed jugular pulse is first observed followed by a watery diarrhea and usually by the accumulation of excessive fluid in the pleural and peritoneal cavities. As the case develops over a period of two to three weeks, the ventral edema becomes more marked (Fig. 1) and straw-colored fluid may accumulate in the body cavities until the abdomen is distended and breathing labored. Death may occur as a result of respiratory failure due to the large volume of pleural fluid or from general debilitation as a result of the right ventricular failure. The incidence of this type of heart failure in Montana cattle is highest on moist mountain valleys. Eighty-one of 113 cases observed over a seven year period occurred in cattle that were maintained at altitudes of 1525 m or below. This paper describes the conditions under which the disease occurs in Montana and compares the hemograms of clinically ill and healthy cattle.
The serological presence of heartworm in dogs of Montana was studied in a 3-yr survey. Serum samples were provided by veterinary practitioners throughout Montana or were submitted to the state diagnostic laboratory. Sera from 3,490 dogs were tested using an enzyme-linked immunosorbent assay (ELISA) for circulating adult heartworm antigen. Twenty-four serum samples were positive for heartworm antigen. Two were from dogs that had never been outside the state. Nineteen additional positive dogs, 7 of which presumably had never been out of the state, were reported through correspondence with veterinary practitioners. Because suitable vectors for Dirofilaria immitis exist in Montana, there is potential for propagation of heartworm.
1. Crude venom gland extracts (VGE) were prepared from female Delena cancerides and Isopeda montana spiders. The VGE were tested in isolated rat atrial, caudal artery and pithed rat preparations for pharmacological activity. 2. In rat isolated atrial preparations, D. cancerides and I. montana VGE, each in a concentration of 2 glands/mL, produced increases in atrial rate which were abolished by propranolol (1 mumol/L) but not by ketanserin (0.1 mumol/L) or reserpine pretreatment (2.5 mg/kg s.c. 24 h prior to experimentation) indicating a direct action on atrial beta-adrenoceptors. 3. In rat caudal artery preparations each VGE produced an increase in perfusion pressure, which was taken as an index of vasoconstriction. Pressor responses to D. cancerides VGE (1 gland/mL) were abolished in the presence of prazosin (1 mol/L) but not by reserpine pretreatment, indicating an action of the VGE on vascular alpha 1-adrenoceptors. Neither prazosin nor reserpine pretreatment had any effect on pressor responses of rat caudal artery preparations to I. montana VGE. Ketanserin (6 nmol/L) produced a small reduction in the degree of vasoconstriction produced by the VGE. This demonstrates a lack of alpha 1-adrenoceptor agonist activity of the VGE. 4. Both VGE produced dose-dependent increases in mean arterial pressure and heart rate in pithed rat preparations. The use of relatively selective receptor antagonists indicated that the increases in mean arterial pressure (MAP) produced by both VGE were mediated by an action on alpha 2-adrenoceptors.
We asked if fleas more frequently remain on those California ground squirrels (Spermophilus beecheyi) that are likely to emigrate from their natal nest. In Camp Ohlone, Alameda County, California, juvenile male squirrels were infested with more fleas (Oropsylla montana) than were juvenile females, and juveniles of both sexes were infested with more fleas (O. montana and Hoplopsyllus anomalus) than adults. There was no difference between the adult sexes in the number of fleas. The disproportionate infestation of male juveniles was accounted for almost exclusively by male O. montana. Greater activity on the part of juvenile males did not account for this difference; the activity of male and female juveniles was very similar. As yearlings, male squirrels established home ranges at greater distances from the natal burrow than did females. Remaining on ranging male squirrels might help male fleas find nonsibling mates in new nests, whereas female fleas might tend to stay in the natal nest in order to assure their progeny of its resources. Flea behavior, modified by characteristics of the host that are sex-specific and predictive of future traits, such as the tendency to range, may thus determine the nature and extent of infestations in juvenile squirrels.
BACKGROUND: The community of Libby, Montana has recently been the focus of national attention secondary to widespread amphibole contamination associated with vermiculite mining and processing. METHODS: Patients who had occupational and non-occupational exposure to amphibole asbestos in Libby, Montana were evaluated for progressive loss of pulmonary function. RESULTS: Of the 123 patients evaluated, 94 demonstrated average age-corrected accelerated loss per year of vital capacity at 3.2%, total lung capacity (TLC) 2.3%, and DLCO 3.3%. All patients all had predominantly pleural changes with minimal to no interstitial disease. CONCLUSIONS: The study demonstrates a progressive loss of pulmonary function in patients exposed to tremolite asbestos.
To characterize the partitioning of metals in a stream ecosystem, concentrations of trace metals including As, Cd, Cu, Pb, and Zn were measured in water, colloids, sediment, biofilm (also referred to as aufwuchs), macroinvertebrates, and fish collected from the Boulder River watershed, Montana. Median concentrations of Cd, Cu, and Zn in water throughout the watershed exceeded the U.S. EPA acute and chronic criteria for protection of aquatic life. Concentrations of As, Cd, Cu, Pb, and Zn in sediment were sufficient in the tributaries to cause invertebrate toxicity. The concentrations of As, Cu, Cd, Pb, and Zn in invertebrates from lower Cataract Creek (63, 339, 59, 34, and 2,410 microg/g dry wt, respectively) were greater than the concentrations in invertebrates from the Clark Fork River watershed, Montana (19, 174, 2.3, 15, and 648 microg/g, respectively), that were associated with reduced survival, growth, and health of cutthroat trout fed diets composed of those invertebrates. Colloids and biofilm seem to play a critical role in the pathway of metals into the food chain and concentrations of As, Cu, Pb, and Zn in these two components are significantly correlated. We suggest that transfer of metals associated with Fe colloids to biological components of biofilm is an important pathway where metals associated with abiotic components are first available to biotic components. The significant correlations suggest that Cd, Cu, and Zn may move independently to biota (biofilm, invertebrates, or fish tissues) from water and sediment. The possibility exists that Cd, Cu, and Zn concentrations increase in fish tissues as a result of direct contact with water and sediment and indirect exposure through the food chain. However, uptake through the food chain to fish may be more important for As. Although As concentrations in colloids and biofilm were significantly correlated with As water concentrations, As concentrations in fish tissues were not correlated with water. The pathway for Pb into biological components seems to begin with sediment because concentrations of Pb in water were not significantly correlated with any other component and because concentrations of Pb in the water were often below detection limits.
Russian olive (Elaeagnus angustifolia L.) was introduced in 1950 onto one site on the Milk River floodplain, northern Montana, 10 km downstream from the Canada/United States border. To analyze dispersal of Russian olive from the point source between 1950 and 1999, we compared distribution, numbers, size structure, and mortality of Russian olive and plains cottonwood (Populus deltoides Marsh:) on an unregulated reach of the Milk River floodplain in southeastern Alberta and north-central Montana. Within 50 years, Russian olive in this reach has moved upriver into Alberta and downriver to the Fresno Reservoir. It is now present on 69 of the 74 meander lobes sampled, comprising 34%, 62%, and 61% of all Russian olive and plains cottonwood seedlings, saplings, and trees, respectively. On some meander lobes, Russian olive has colonized similar elevations on the floodplain as plains cottonwood and is oriented in rows paralleling the river channel, suggesting that recruitment may be related to river processes. Breakup ice had killed 400 Russian olive saplings and trees and damaged >1000 others on 30 of the meander lobes in 1996. Nevertheless, Russian olive now outnumbers cottonwood on many sites on the Milk River floodplain because its seeds can be dispersed by wildlife (particularly birds) and probably by flood water and ice rafts; seeds are viable for up to 3 years and germination can take place on bare and well-vegetated soils; and saplings and trees are less palatable to livestock and beaver than plains cottonwood. Without control, Russian olive could be locally dominant on the Milk River floodplain in all age classes within 10 years and replace plains cottonwood within this century.
Throughout August and September, 2003, wildfires burned in close proximity to Missoula, Montana, with smoke emanating from the fires impacting the valley for much of the summer. This presented the perfect opportunity to measure the levels of polychlorinated dibenzodioxins and dibenzofurans (PCDD/F) comprising ambient forest fire smoke particles impacting the Missoula Valley. An air sampler at the Montana Department of Environmental Quality's (DEQ) compliance site in Missoula measured hourly averages of PM(10) throughout the fire season. Three collocated PM(2.5) cyclones collected 24-h smoke samples using quartz filters and Polyurethane Foam (PUF) sorbent cartridges. From the quartz filters, concentrations of Organic and Elemental Carbon (OC/EC) were measured, while PCDD/F were measured from one set of a filter (particle phase) and PUF (vapor phase) aggregate of samples in an attempt to also investigate the different phases of PCDD/F in forest fire smoke impaired communities. Hourly PM(10) concentrations peaked at 302.9 microg m(-3) on August 15. The highest OC concentration (115.6 microg m(-3)) was measured between August 21-22, and the highest EC concentration of 10.5 microg m(-3) was measured August 20-21. Measurable concentrations of PM(2.5) associated PCDD/Fs were not detected from a representative aggregate sample, with the exception of small amounts of 1,2,3,4,6,7,8-heptachlorodibenzodioxin and octachlorodibenzodioxin. PM(2.5) samples collected during the smoke events were composed of approximately 65% OC. However, the OC fraction of the particles collected in the smoke impaired Missoula valley was not composed of significant amounts of PCDD/F.
A description of an ongoing program for the prevention of fetal alcohol syndrome (FAS) and other alcohol-related birth defects (ARBDs) is provided. The prevention program focuses on women with increased risk factors. Paraprofessionals were added to selected professional case management teams in Montana in both rural and urban settings. The pilot program is linked with existing public health programs that are in place to help decrease the mortality of infants in Montana. A quasi-experimental design is being utilized to determine the efficacy of the prevention program in reducing risk factors that lead to alcohol use during pregnancy.
OBJECTIVES: To estimate the prevalence and incidence of type 2 diabetes among American Indian youth. STUDY DESIGN: Medical records were reviewed annually for all patients with diabetes who were <20 years of age at 6 Indian Health Service facilities in Montana and Wyoming. All cases < or =5 years of age or weight per age < or =10th percentile at diagnosis or with islet cell antibodies were considered as probable type 1. Among the remaining cases, probable type 2 diabetes was defined when a child had one or more of the following characteristics: weight per age > or =95th percentile or acanthosis nigricans at diagnosis, elevated C-peptide or insulin, family history of type 2 diabetes; treatment with oral agents with or without insulin or no hypoglycemic therapy after 1 year of follow-up. RESULTS: From 1999 to 2001, 53% of prevalent cases and 70% of incident cases were categorized as probable type 2 diabetes. The average annual prevalence of probable type 1 and type 2 diabetes was 0.7 and 1.3 per 1000. The average annual incidence rates for probable type 1, and type 2 diabetes were 5.8, 23.3 per 100,000. CONCLUSIONS: The incidence of probable type 2 diabetes was approximately 4 times higher than type 1 diabetes among American Indian youth in Montana and Wyoming
When Dr. D. Corydon Hammond invited me to write a paper for this symposium on hypnosis training, it was obvious that its greatest contribution could be a description of the rather intensive program developed over 2 decades at the University of Montana. However, it became apparent that the Montana program was only part of some 50 years experience developing professional education in hypnosis, psychotherapy, and graduate training in general. At the risk of being accused of immodesty I must therefore write much of this contribution in the first person.
PURPOSE: To explore the licensing, certification, governance and education requirements of nurse practitioners (NPs) and physician assistants (PAs) in the state of Montana. Services provided and privileges retained in employment were also analyzed. DATA SOURCES: This was a descriptive study using a survey of rural hospital administrators (N = 34). CONCLUSIONS: Survey results show that 92.5% of PAs in Montana meet their supervision requirement by a telephone contact provision outlined by the state board of medicine. In contrast, 54.2% of NPs, who are autonomous by legal definition, have a telephone supervision requirement imposed on them by their employers. IMPLICATIONS FOR PRACTICE: These findings have implications for the current and prospective professionals and the businesses for which they work. Nurse practitioners and their professional organizations need to consider the implications these findings have on the professional image and marketability of all NPs.
BACKGROUND: Fibrous tremolite is a widespread amphibole asbestiform mineral, airborne fibres of which constitute an environmental hazard in Libby, Montana, northern California, and elsewhere. AIMS: To determine excess risk from lung cancer, mesothelioma, and all-cause mortality in a cohort of men exposed to tremolite, but no other form of asbestos. METHODS: Mortality by certified cause and various measures of exposure to tremolite and related amphibole fibres was assessed in a cohort of 406 vermiculite mineworkers in Libby, Montana, employed before 1963 and followed until 1999. RESULTS: Total deaths were: lung cancer 44 (SMR 2.40), non-malignant respiratory disease (NMRD) 51 (SMR 3.09), all causes 285 (SMR 1.27); included among the total were 12 deaths ascribed to mesothelioma (4.21% of all deaths). Adjusted linear increments in relative risks (per 100 f/ml.y), estimated by Poisson regression, were: lung cancer (0.36, 95% CI 0.03 to 1.20), NMRD (0.38, 95% CI 0.12 to 0.96), and all deaths (0.14, 95% CI 0.05 to 0.26). CONCLUSIONS: The all-cause linear model would imply a 14% increase in mortality for mine workers exposed occupationally to 100 f/ml.y or about 3.2% for a general population exposed for 50 years to an ambient concentration of 0.1 f/ml. Amphibole fibres, tremolite in particular, are likely to be disproportionately responsible for cancer mortality in persons exposed to commercial chrysotile, but to what extent cannot be readily assessed.
BACKGROUND: Disparities in stroke and heart disease have been well defined in many populations in the United States. Relatively few studies, however, have assessed current disparities in cardiovascular disease in American Indian populations and compared trends with other regions of the United States. METHODS AND RESULTS: Using mortality data, age-adjusted all-cause, heart disease, and stroke mortality rates (per 100,000) were calculated for American Indians and whites from 1991 to 1995 and 1996 to 2000. The all-cause mortality rate was strikingly higher for American Indians than for whites. For example, during 1996 to 2000, the all-cause mortality rate for American Indians (1317, +/-61) was more than half again greater than that for whites (831, +/-8). Heart disease mortality declined significantly in whites (237 to 216 per 100,000) in Montana over the past decade and declined, although not significantly, in American Indians (326 to 283 per 100,000). Stroke mortality also declined significantly in whites (64 to 60 per 100,000) but not in American Indians (80 to 81 per 100,000) during this time period. The proportion of deaths before age 65 years for heart disease and stroke was considerably higher in Indian men (45% and 36%) and Indian women (29% and 28%) compared with white men (21% and 11%) and white women (8% and 7%). CONCLUSIONS: The disparity in heart disease and stroke mortality exists between American Indians and whites in Montana. Regional or state-level surveillance data will be needed to describe the changing patterns of heart disease and stroke mortality and cardiovascular risk factors in many native communities in the United States and Canada.
In 1979, Montana's insanity defense was replaced with the more restrictive mens rea defense, a change that has been described as an example of "abolition" of the insanity defense. The authors identified cases in which mental health was an issue in seven Montana counties for 3 years before and 3 years after the 1979 reform. They found that acquittals based on the insanity plea markedly declined, but that dismissals based on incompetence to stand trial increased substantially following the reform. They conclude that dismissal based on incompetence to stand trial became a substitute for acquittal based on the insanity plea under mens rea.
Systemic autoimmune responses are associated with certain environmental exposures, including crystalline particles such as silica. Positive antinuclear antibody (ANA) tests have been reported in small cohorts exposed to asbestos, but many questions remain regarding the prevalence, pattern, and significance of autoantibodies associated with asbestos exposures. The population in Libby, Montana, provides a unique opportunity for such a study because of both occupational and environmental exposures that have occurred as a result of the mining of asbestos-contaminated vermiculite near the community. As part of a multifaceted assessment of the impact of asbestos exposures on this population, this study explored the possibility of exacerbated autoimmune responses. Age- and sex-matched sets of 50 serum samples from Libby and Missoula, Montana (unexposed), were tested for ANA on HEp-2 cells using indirect immunofluorescence. Data included frequency of positive tests, ANA titers, staining patterns, and scored fluorescence intensity, all against known controls. Serum immunoglobulin A (IgA), rheumatoid factor, and antibodies to extractable nuclear antigen (ENA) were also tested. The Libby samples showed significantly higher frequency of positive ANA and ENA tests, increased mean fluorescence intensity and titers of the ANAs, and higher serum IgA, compared with Missoula samples. In the Libby samples, positive correlations were found between ANA titers and both lung disease severity and extent of exposure. The results support the hypothesis that asbestos exposure is associated with autoimmune responses and suggests that a relationship exists between those responses and asbestos-related disease processes.