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PubMed2003

Cardiovascular risk factors in Montana American Indians with and without diabetes.

BACKGROUND: Cardiovascular disease (CVD) and diabetes are prevalent and of major concern for American-Indian communities in the United States. Health professional counseling is effective in increasing patient awareness and inducing lifestyle modification. The objective of this study was to compare the prevalence of CVD, modifiable risk factors and counseling for smoking cessation, physical activity, and a healthy diet in adult American Indians with and without diabetes. METHODS: A random sample of adult American Indians living on or near the seven Montana reservations was interviewed through an adapted Behavioral Risk Factor Surveillance System telephone survey in 1999 (N=1000) and 2001 (N=1006). RESULTS: Respondents with diabetes, compared to those without, had a significantly higher prevalence of CVD (27% vs 8%); overweight (89% vs 71%); high blood pressure (57% vs 24%); and high cholesterol (44% vs 22%). There were no differences for insufficient physical activity (60% vs 51%) or smoking (34% vs 41%) after adjustment for age, gender, and survey year. Respondents with diabetes, compared to respondents without diabetes, were significantly more likely to report health professional counseling for smoking cessation (83% vs 58%); physical activity (73% vs 37%); and reduced fat consumption (57% vs 24%). CONCLUSIONS: The prevalence of modifiable CVD risk factors was alarmingly high among adult American Indians with and without diabetes. Strategies to increase health professional counseling for healthy diet and smoking cessation are needed.

Adult↗
PubMed2005

Biogeochemical controls on Diel cycling of stable isotopes of dissolved O2 and dissolved inorganic carbon in the Big Hole River, Montana.

Rivers with high biological productivity typically show substantial increases in pH and dissolved oxygen (DO) concentration during the day and decreases at night, in response to changes in the relative rates of aquatic photosynthesis and respiration. These changes, coupled with temperature variations, may impart diel (24-h) fluctuations in the concentration of trace metals, nutrients, and other chemical species. A better understanding of diel processes in rivers is needed and will lead to improved methods of data collection for both monitoring and research purposes. Previous studies have used stable isotopes of dissolved oxygen (DO) and dissolved inorganic carbon (DIC) as tracers of geochemical and biological processes in streams, lakes, and marine systems. Although seasonal variation in 6180 of DO in rivers and lakes has been documented, no study has investigated diel changes in this parameter. Here, we demonstrate large (up to 13%o) cycles in delta18O-DO for two late summer sampling periods in the Big Hole River of southwest Montana and illustrate that these changes are correlated to variations in the DO concentration, the C-isotopic composition of DIC, and the primary productivity of the system. The magnitude of the diel cycle in delta18O-DO was greater in August versus September because of the longer photoperiod and warmer water temperatures. This study provides another biogeochemical tool for investigating the O2 and C budgets in rivers and may also be applicable to lake and groundwater systems.

Anions↗
PubMed2003

Dietary intake, eating behavior, and physical activity-related determinants of high body mass index in rural communities in Wyoming, Montana, and Idaho.

OBJECTIVE: To assess the relation between body mass index (BMI) levels and various lifestyle variables related to physical activity and specific characteristics of a healthy eating pattern, using baseline cross-sectional data from the Wellness IN the Rockies project. SUBJECTS: A total of 928 males and 889 females, aged 18-99 y, recruited from six rural communities in Wyoming, Montana, and Idaho. MEASUREMENTS: Using BMI as the criterion, overweight was defined as a BMI >or=25 kg/m(2) and obesity was defined as a BMI >or=30 kg/m(2). All participants in this study completed a questionnaire that elicited sociodemographic information, self-reported height and weight, and data related to specific dietary intakes, eating-related behaviors, and physical activity behaviors and perceptions. RESULTS: Prevalence of overweight was 70% in men and 59% in women. Increased likelihood of overweight or obesity was associated with greater frequency of the following: drinking sweetened beverages such as soft drinks/soda pop, ordering supersized portions, eating while doing other activities, and watching television. Other predictors were lower frequency of participation in physical activity and the perception of not getting as much exercise as needed. CONCLUSIONS: The increased probability of having a high BMI in individuals who more often eat while doing another activity appears to be a novel finding that will need to be substantiated by additional research. The finding that the vast majority of overweight and obese respondents believed that they do not get as much exercise as needed strengthens the assertion that finding ways to increase participation in physical activity should remain a high priority in obesity prevention and intervention efforts at the community and individual levels.

Adolescent↗
PubMed2000

Clypeatula cooperensis gen. n., sp. n., a new freshwater sponge (Porifera, Spongillidae) from the Rocky Mountains of Montana, USA.

A new genus and species of freshwater sponge, Clypeatula cooperensis, collected from three lakes in the Northern Rocky Mountains of Montana, USA, are described. The sponge grows as a hard, disc-shaped encrustation on the undersides of rocks and logs. It lacks microscleres and has amphioxeal megascleres that often show a slight midregion bulb and are usually covered with short, conical spines except at their tips. The sponge is also non-gemmulating, overwintering in a regressed state in which choanocyte chambers are reduced in number. Phylogenetic analyses of complete 18S rDNA sequences of C. cooperensis, Ephydatia muelleri, Spongilla lacustris and Eunapius fragilis suggest that C. cooperensis is more closely related to Ephydatia muelleri than to Spongilla lacustris or Eunapius fragilis. Our data, nonetheless, do not rule out the possibility that C. cooperensis is more closely related to the non-gemmulating sponges of Lake Baikal (Russia) than it is to Ephydatia muelleri. These phylogenetic analyses support the erection of a new genus, the monophyly of freshwater sponges belonging to the families Spongillidae and Lubomirskiidae, and the monophyly of demosponges.

Acclimatization↗
PubMed2006

A review of the federal government's health activities in response to asbestos-contaminated ore found in Libby, Montana.

Vermiculite ore is a naturally occurring fibrous mineral widely used in various consumer products, such as attic insulation, lawn and garden products, and fireproofing material. While most vermiculite ore and products do not pose a health hazard, the vermiculite mined from Libby, MT was contaminated with naturally occurring asbestos. The federal Agency for Toxic Substances and Disease Registry (ATSDR) has documented a significant number of asbestos-related deaths among Libby residents. Additionally, as part of the ongoing investigation, ATSDR has learned that this contaminated ore was shipped to hundreds of locations around the United States for processing. While the Libby mine is now closed, studies from ATSDR and elsewhere show that people who worked in the Libby mine or vermiculite processing facilities may have been exposed to hazardous levels of asbestos while the facilities were in operation. People who lived or worked near these sites also may have been exposed to asbestos if they came into contact with contaminated vermiculite. Prolonged exposure to asbestos can cause serious and life-threatening health conditions, including asbestosis, lung cancer, and mesothelioma. In response, ATSDR has initiated 10 different activities to help evaluate the potential health effects among Libby residents and populations throughout the United States who might have been exposed to the asbestos-contaminated ore found in Montana. Some of these activities include conducting environmental exposure evaluations, health statistics reviews, community screenings, and disease-specific surveillance. This article presents the various follow-up activities that have been conducted to date by ATSDR and partnering state health departments.

Aluminum Silicates↗
PubMedDate not supplied

Assessing the reproductive behavior of on- and off-reservation American Indian females: characteristics of two groups in Montana.

Only limited fertility and general reproductive health data exist on American Indians. Using data from the 1987 Montana American Indian Health Risk Assessment, we found that the fertility of American Indians in Great Falls and on the Blackfeet Reservation was similar to blacks in the U.S. and relatively high when compared with fertility of whites in the United States. The influence of the direct determinants of fertility (nuptiality, contraceptive use, and lactation) was very different for the populations examined in this study. Great Falls American Indians and the U.S. black population were similar regarding age at first sexual intercourse (very young), breastfeeding (low prevalence and short duration), planning status of pregnancies (high unplanned), and contraceptive use (only moderate use). In contrast, Blackfeet women on the reservation and the U.S. white population married relatively late, had very high contraceptive use, used effective methods of contraception, and had moderately high levels of breastfeeding. However, Blackfeet fertility was much higher than that of whites. Three interrelated reasons are suggested as possible explanations. Blackfeet couples either wanted high fertility, were relatively poor users of family planning methods, or used less effective methods until they had exceeded their desired family size after which time they turned to sterilization. These finds raise numerous questions concerning the social and economic factors that may account for these group similarities and differences. Further studies with much larger data sets are needed to address these issues adequately.

Adolescent↗
PubMed2003

Shiga toxin-producing Escherichia coli in Montana: bacterial genotypes and clinical profiles.

The diseases and virulence genes associated with Shiga toxin-producing Escherichia coli (STEC) are characterized incompletely. We analyzed, by polymerase chain reaction, 82 STEC isolates collected prospectively in Montana and profiled associated illnesses by patient chart review. All E. coli O157:H7 contained stx2-group genes, as well as eae, iha, espA, and ehxA; 84% contained stx1. Non-O157:H7 STEC less frequently contained stx1 (P=.046), stx2 (P<.001), iha (P<.001), eae, and espA (P=.039 for both), were isolated less often from patients treated in emergency departments (P=.022), and tended to be associated less frequently with bloody diarrhea (P=.061). There were no significant associations between stx genotype and bloody diarrhea, but isolates containing stx2c or stx(2d-activatable) were recovered more often from patients who underwent diagnostic or therapeutic procedures (P=.033). Non-O157:H7 STEC are more heterogeneous and cause bloody diarrhea less frequently than do E. coli O157:H7. Bloody diarrhea cannot be attributed simply to the stx genotype of the infecting organism.

Adolescent↗
PubMed2005

First record of hosts for tick Carios kelleyi (Acari: Ixodida: Argasidae) in Canada and Montana.

I found Carios kelleyi Cooley & Kohls (formerly Ornithodoros kelleyi) (Acari: Ixodida: Argasidae) on five species of bats (Eptesicusfuscus, Myotis lucifugus, Myotis ciliolabrum, Myotis evotis, and Myotis volans) in the prairies of southeastern Alberta and north central Montana. This is the first occurrence of ticks on bats in Canada. This is also the first record of C. kelleyi on M. evotis and M. volans. Dates of parasitization ranged from 22 May to 17 October, and the number of ticks per host ranged from 1 to 44 (median two ticks per host). Number of parasitized individuals was significantly higher in rock-roosting E. fuscus compared with building-roosting E. fuscus, rock- and building-roosting M. lucifugus, and rock-roosting M. ciliolabrum and M. evotis. A significant sex bias was noted in rock-roosting E. fuscus in 2000 with significantly more females parasitized. The number of ticks per bat host was highest in 2001, corresponding to the driest and hottest summer of the survey.

Animals↗
PubMed2005

Physiological responses of ponderosa pine in western Montana to thinning, prescribed fire and burning season.

Low-elevation ponderosa pine (Pinus ponderosa Dougl. ex. Laws.) forests of the northern Rocky Mountains historically experienced frequent low-intensity fires that maintained open uneven-aged stands. A century of fire exclusion has contributed to denser ponderosa pine forests with greater competition for resources, higher tree stress and greater risk of insect attack and stand-destroying fire. Active management intended to restore a semblance of the more sustainable historic stand structure and composition includes selective thinning and prescribed fire. However, little is known about the relative effects of these management practices on the physiological performance of ponderosa pine. We measured soil water and nitrogen availability, physiological performance and wood radial increment of second growth ponderosa pine trees at the Lick Creek Experimental Site in the Bitterroot National Forest, Montana, 8 and 9 years after the application of four treatments: thinning only; thinning followed by prescribed fire in the spring; thinning followed by prescribed fire in the fall; and untreated controls. Volumetric soil water content and resin capsule ammonium did not differ among treatments. Resin capsule nitrate in the control treatment was similar to that in all other treatments, although burned treatments had lower nitrate relative to the thinned-only treatment. Trees of similar size and canopy condition in the three thinned treatments (with and without fire) displayed higher leaf-area-based photosynthetic rate, stomatal conductance and mid-morning leaf water potential in June and July, and higher wood radial increment relative to trees in control units. Specific leaf area, mass-based leaf nitrogen content and carbon isotope discrimination did not vary among treatments. Our results suggest that, despite minimal differences in soil resource availability, trees in managed units where basal area was reduced had improved gas exchange and growth compared with trees in unmanaged units. Prescribed fire (either in the spring or in the fall) in addition to thinning, had no measurable effect on the mid-term physiological performance and wood growth of second growth ponderosa pine.

Fires↗
PubMed1989

Cesium-137 in Montana soils.

Fallout 137Cs levels in soil were measured at 11 diverse sites throughout Montana. Concentrations in near-surface samples ranged from 20-200 mBq g-1 (0.51-5.41 pCi g-1). Most of the 137Cs was in the top 10 cm of soil. Deeper occurrences were attributed to disturbances by animals and to interstitial flow of small sediment particles within saturated soils. The areal concentrations ranged from 130-748 mBq cm-2 (3.6-20.2 pCi cm-2) and were highly correlated with annual precipitation.

Cesium Radioisotopes↗
PubMed1999

Analysis of preventable pediatric trauma deaths and inappropriate trauma care in Montana.

OBJECTIVE: To determine the rates of preventable mortality and inappropriate care, as well as the nature of treatment errors associated with pediatric traumatic deaths occurring in a rural state. METHODS: Retrospective multidisciplinary consensus panel review of deaths attributed to mechanical trauma in children aged 18 years or less, occurring in Montana between October 1, 1989, and September 30, 1992. The care rendered in both preventable and nonpreventable cases was evaluated for appropriateness according to nationally accepted guidelines. Rates of pediatric preventable death and inappropriate care, as well as the nature of inappropriate care, were compared with that of the adult population. RESULTS: One hundred thirty-eight cases were reviewed. One death (less than 1%) was judged frankly preventable, 11 deaths (8%) were judged possibly preventable, giving a total preventability rate of 9% for all cases reviewed. Considering only in-hospital deaths (n = 77), the total preventability rate was 16%. The rate of inappropriate care rendered for all deaths, regardless of preventability, was 36%. The rate of inappropriate care in the prehospital phase was 16%; for in-hospital deaths, it was 47%. In the emergency department (ED), the rate was 36%, and in post-ED care, 22%. In comparison to the adult population, the rates of preventable death (9% vs. 14%) and inappropriate care in the hospital phase (64% vs. 66%) were lower. Inappropriate care for the pediatric group was more prevalent in patients less than or equal to 14 years old. The nature of inappropriate care was most frequently associated with the management of respiratory problems, including airway control and management of chest trauma. CONCLUSION: Preventable mortality from traumatic injuries in children in a rural state appears to be low, and lower than that reported for adult trauma victims in the same state. A preponderance of these preventable deaths occur in the subgroup of children less than or equal to 14 years if age. Inappropriate trauma care in children occurs frequently, particularly in the ED phase of care, and is primarily associated with the management of the airway and chest injuries. Education of ED primary care providers in basic principles of stabilization and initial treatment of the injured child 14 years old or younger may be the most effective method of reducing preventable trauma deaths in the rural setting.

Adolescent↗
PubMed1997

Rickettsia peacockii sp. nov., a new species infecting wood ticks, Dermacentor andersoni, in western Montana.

Rickettsia peacockii, a new species of spotted fever group rickettsiae, was identified from Rocky Mountain wood ticks (Dermacentor andersoni) collected in the Sapphire Mountain Range on the eastern side of Bitterroot Valley, Montana. DNA from R. peacockii SkalkahoT (T = type strain) in naturally infected tick tissue was amplified by a PCR assay with primer sets derived from eubacterial 16S ribosomal DNA (rDNA), rickettsial citrate synthase, and 190-kDa surface antigen (rOmpA) genes. Partial 16S rDNA and rOmpA gene sequences exhibited levels of similarity of 99.7 and 93.2%, respectively, with the sequences of the spotted fever agent Rickettsia rickettsii R. By using Gimenez staining, fluorescent antibody tests, a PCR assay, and a restriction fragment length polymorphism analysis, 76 of 115 female ticks (minimal field infection rate, 66.1%) collected between 1992 and 1995 were found to be infected. The organism is passed transstadially and transovarially (minimal vertical transmission rate, 73.3%), and infections are localized in ovarial tissues. Attempts to cultivate R. peacockii were unsuccessful.

Amino Acid Sequence↗
PubMed1999

Community decision-making about critical access hospitals: lessons learned from Montana's Medical Assistance Facility Program.

Limited-service hospitals have been used as a means of maintaining health care services in rural communities with full-service hospitals at risk of closure. The Medical Assistance Facility (MAF) limited-service hospital model has been implemented in 12 communities in Montana and has been evaluated by the Health Care Financing Administration as a viable alternative to a full-service hospital in frontier communities. The 1997 federal Critical Access Hospital (CAH) legislation is the most recent nationwide alternative for maintaining health care in rural communities, and it incorporates many of the features of the MAF model. The purpose of this study was to examine rural community decision making regarding MAF conversion from the perspectives of key informants who were involved in the decision-making process. A descriptive multiple case study design was used. Data were obtained through interviews with community members during site visits. The research focused on identification of local issues that were influential in the decision to convert to or reopen as an MAF, features of the MAF model that made it a locally acceptable alternative, and elements that characterized the decision-making process. The issues found to be influential in the conversion decision and the features that made the MAF locally acceptable were those that made the provision of basic services more stable and sustainable. The study suggests that programs to maintain health care services in isolated communities should allow for and encourage an expanded role for nonphysician providers. The lessons learned from the communities included in this study are instructive to rural communities nationwide that are considering a CAH as well as to policy-makers, researchers, and regional and national health care decision makers.

Community-Institutional Relations↗
PubMed2006

Availability of diagnostic and treatment services for acute stroke in frontier counties in Montana and Northern Wyoming.

CONTEXT: Rapid diagnosis and treatment of ischemic stroke can lead to improved patient outcomes. Hospitals in rural and frontier counties, however, face unique challenges in providing diagnostic and treatment services for acute stroke. PURPOSE: The aim of this study was to assess the availability of key diagnostic technology and programs for acute stroke evaluation and treatment in Montana and northern Wyoming. METHODS: In 2004, hospital medical directors or their designees were mailed a survey about the availability of diagnostic technology, programs, and personnel for acute stroke care. FINDINGS: Fifty-eight of 67 (87%) hospitals responded to the survey. Seventy-nine percent (46/58) of responding hospitals were located in frontier counties, with an average bed size of 18 (11 SD). Of the hospitals in frontier counties, 44% reported emergency medical services prehospital stroke identification programs, 39% had 24-hour computed tomography capability, 44% had an emergency department stroke protocol, and 61% had a recombinant tissue plasminogen activator protocol. Thirty percent of hospitals in frontier counties reported that they met 6-10 of the criteria established by the Brain Attack Coalition to improve acute stroke care compared to 67% of hospitals in the nonfrontier counties. CONCLUSION: A stroke network model could enhance care and improve outcomes for stroke victims in frontier counties.

Acute Disease↗
PubMed1998

Acceptance of amniocentesis by women in the state of Montana (USA) who are screen positive for Down's syndrome.

OBJECTIVE: To assess factors influencing uptake of amniocentesis after a positive Down's syndrome screening result. METHODS: Interviews of 53 Montana women with screening risks > or = 1 in 300 after delivery. RESULTS: Thirty had accepted amniocentesis ("yes" group) and 23 had declined ("no" group) (57% uptake). Age at delivery was significantly higher (p = 0.02) for the "no" than the "yes" group (mean 35.3 nu 31.7 years). The mean risk of Down's syndrome ascertained by screening was 1 in 190 for the "no" group and 1 in 115 for the "yes" group (p = 0.05). Statistically significant differences (p < or = 0.05) between opinions in the two groups included: (a) desire to know if the fetus had Down's syndrome; (b) perception of the burden of care for an affected child; (c) support of doctor, spouse, and relatives for choice about amniocentesis; (d) attitudes toward abortion; (e) importance of religion; and (f) concerns about the amniocentesis procedure. The most important factor for those choosing amniocentesis was knowing if the fetus had Down's syndrome, and for those not choosing amniocentesis, attitude about abortion. CONCLUSION: Our results show the need for prescreening education to enable pregnant women to make informed decisions about screening for Down's syndrome and diagnostic testing.

Adult↗
PubMedDate not supplied

Patterns of asthma symptoms and perceptions of harm from seasonal atmospheric events in rural Western Montana.

To characterize the frequency of and relationship between self-reported asthma symptoms and physician-diagnosed asthma, identify seasons associated with heightened symptoms, and describe the influence of seasonal atmospheric events and ambient environmental factors on asthma symptoms and perceptions of harm, a seven-county region of Western Montana was surveyed, utilizing a two-stage sampling method. Respondents were queried concerning asthma-related history, symptoms, and environmental concerns. Of 2,790 respondents, 12% reported physician-diagnosed asthma. Eighteen percent reported one or more and 9% reported two or more asthma-related symptoms. Over 70% of asthmatics reported worsened asthma symptoms during wildland-fire smoke exposure. Of those reporting summer as the season they experienced the greatest breathing problems, 81% reported breathing problems from wildland-fire smoke (p < 0.01). Of those reporting worsened symptoms in fall or winter, 61% reported breathing problems during winter inversions (p < 0.001).

Adolescent↗
PubMed2003

Radiographic abnormalities and exposure to asbestos-contaminated vermiculite in the community of Libby, Montana, USA.

Mining, handling, processing, and personal or commercial use of asbestos-contaminated vermiculite have led to widespread contamination of the Libby, Montana, area. We initiated a medical testing program in response to reports of respiratory illness in the community. The purpose of this analysis was to identify and quantify asbestos-related radiographic abnormalities among persons exposed to vermiculite in Libby and to examine associations between these outcomes and participants' self-reported exposures. A cross-sectional interview and medical testing were conducted in Libby from July through November 2000 and from July through September 2001. A total of 7,307 persons who had lived, worked, or played in Libby for at least 6 months before 31 December 1990 completed the interview. Of those, 6,668 participants > or = 18 years of age received chest radiographs to assess the prevalence of pleural and interstitial abnormalities. We observed pleural abnormalities in 17.8% of participants and interstitial abnormalities in < 1% of participants undergoing chest radiography. We examined 29 occupational, recreational, household, and other exposure pathways in the analysis. The prevalence of pleural abnormalities increased with increasing number of exposure pathways, ranging from 6.7% for those who reported no apparent exposures to 34.6% for those who reported > or = 12 pathways. The factors most strongly associated with pleural abnormalities were being a former W.R. Grace worker, being older, having been a household contact of a W.R. Grace worker, and being a male. In addition to being a former W.R. Grace worker, environmental exposures and other nonoccupational risk factors were also important predictors of asbestos-related radiographic abnormalities.

Adolescent↗
PubMedDate not supplied

Developing a mobile pharmacist-conducted wellness clinic for rural Montana communities.

OBJECTIVE: To describe pharmacist-conducted disease screening services in remote communities. SETTING: Frontier, rural, and nonrural counties throughout western Montana. PRACTICE DESCRIPTION: Using federal telehealth funds, a motor home was converted into a mobile office and equipped with a satellite transmitting/receiving dish to provide wireless Internet access. The pharmacist uses an ultrasound unit to test heel bone density, a spirometer to test lung function, and appropriate analyzers to measure A1C and serum lipid levels. Screening clinics are held in conjunction with county health departments, tribal health authorities, community pharmacies, county agricultural extension agents, and Federally Qualified Health Centers. Employee wellness clinics are also conducted. Student pharmacists assist with screenings. PRACTICE INNOVATION: Mobile pharmacist-conducted disease screening clinics in remote communities. MAIN OUTCOME MEASURES: Number of communities served, number of patients screened, percentage of test results out-of-range/patients referred to their primary health care providers for follow-up, number of student pharmacists participating, and total revenues generated. RESULTS: During the first 2 years of the project, IPHARM pharmacists traveled approximately 14,000 miles, conducted 72 clinics in 17 counties and performed 5,100 screening tests for more than 3,100 people. Approximately 36% of all screening test results were outside of expected range. More than 80 student pharmacists, most of whom were on clinical rotations, participated in the clinics and 11 community pharmacists have been trained to conduct screenings. In excess of dollar 70,000 was generated by the project in operating revenue and donations. At the conclusion of IPHARM's first year of operations, the motor home was taken out of service because of the cost of gasoline, difficulties of winter travel with such a large vehicle, and the realization that virtually all host organizations were able to provide space in which the screening clinics could be conducted. CONCLUSION: Pharmacists and student pharmacists are capable of providing disease screening services in remote frontier and rural communities. Obtaining sufficient payment for these services in rural communities to cover costs remains a challenge.

Adult↗