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PubMedDate not supplied

Extent of services provided by pharmacists in the Iowa Medicaid Pharmaceutical Case Management program.

OBJECTIVE: To summarize the start-up experience with patients identified as eligible during the first four quarters of the Iowa Pharmaceutical Case Management (PCM) program and to characterize the extent of the services proved by pharmacists in the program. DESIGN: Prospective pharmaceutical care intervention project. SETTING: One hundred seventeen community pharmacies in Iowa. PATIENTS: Medicaid patients at high risk for drug-related problems based on using 4 or more nontopical medications and having 1 of 12 specific disease states. INTERVENTION: To become eligible to provide PCM services, licensed pharmacists had to undergo training and submit five care plans to the Iowa Department of Human Services. Community pharmacists were provided names of newly eligible patents each calendar quarter for 1 year. For each patient, pharmacists were asked to indicate by fax whether they had met with the patient, performed a written work-up of the patient, sent recommendations to the patient's physician, and whether the physician replied. When pharmacists were unable to provide the service, they were asked to state the reason. Both the pharmacist and the physician receive $75 for the initial assessment, with additional payments after each follow-up visit performed. MAIN OUTCOME MEASURES: An intensity score and the percentage of eligible patients for whom all steps were completed were calculated for each pharmacy. RESULTS: Fax survey results were retumed for 2,834 (96.7%) of the 2,931 patients eligible for PCM services. Pharmacists met with 943 (33.3%), worked up 763 (26.9%), sent recommendations to physicians for 500 (17.6%), and received replies from physicians for 327 (11.5%) patients. Pharmacists were unable to provide PCM services for 1,891 (66.7%) patients. The primary reasons given for this inability to provide services were patient access issues for 438 (23.2%) patients, pharmacy staffing or start-up issues for 419 (22.2%) patients, or no reason specified for 575 (30.4%) patients. A PCM intensity score was developed to represent the scope of services provided and the number of patients served. A higher intensity score indicated pharmacies that provided PCM to more patients and/or that offered higher levels of care (e.g., provided a written set of recommendations to the physician rather than simply assessing the patient without preparing or sending recommendations). Future evaluations will determine the validity of the score on the basis of patient outcomes. CONCLUSION: Some pharmacies implemented PCM services very effectively. However, 40% to 60% of the pharmacies provided little or no PCM services within 3 months of notification of patient eligibility. Future investigations will evaluate the quality of prescribing and quality of life for patients who received PCM services.

Child↗
PubMed2003

Iowa and Eugene, Oregon, orthopaedics.

Over the last 50 years, the commitment of orthopaedic surgeons to basic and clinical research and evaluation of treatment outcomes has made possible remarkable improvements in the care of people with injuries and diseases of the limbs and spine. A group of Oregon orthopaedic surgeons has had an important role in these advances, especially in the orthopaedic specialties of sports medicine and hip reconstruction. Since Don Slocum (Iowa Orthopaedic Resident, 1934-1937), started practice in Eugene, Oregon, in 1939, three orthopaedic surgeons, Denny Collis, Craig Mohler and Paul Watson, who received their orthopaedic residency education at the University of Iowa, and three orthopaedic surgeons, Stan James, Tom Wuest and Dan Fitzpatrick, who received their undergraduate, medical school and orthopaedic residency education at the University of Iowa, have joined the group Dr. Slocum founded. These individuals, and their partners, established and have maintained a successful growing practice that serves the people of the Willamette valley, but in addition, they have made important contributions to the advancement of orthopaedics.

History, 20th Century↗
PubMed1992

Lead intoxication in Iowa children.

In Iowa, there are over 600,000 residential units built before 1950 which are high risk environments for children due to deteriorating lead paint. However, there are relatively few lead screening programs in Iowa, and only selected children in Iowa have been screened.

Age Factors↗
PubMed2005

West Nile virus serosurveillance in Iowa white-tailed deer (1999-2003).

Sera from white-tailed deer (Odocoileus virginianus) were collected in Iowa during the winter months (1999-2003), 2 years before and after West Nile virus (WNV) was first reported in Iowa (2001), and were analyzed for antibodies to WNV. Samples from 1999 to 2001 were antibody negative by blocking enzyme-linked immunosorbent assay (bELISA) and plaque reduction neutralization test (PRNT(90)). Prevalence derived from bELISA (2002, 12.7%; 2003, 11.2%) and WNV PRNT(90) (2002, 7.9%; 2003, 8.5%) assays were similar. All samples were negative for antibodies against St. Louis encephalitis virus as determined by PRNT(90). Antibodies to flaviviruses were detected by indirect enzyme-linked immunosorbent assay (iELISA) prior to the first WNV cases reported in Iowa (1999-2001) with prevalence ranging from 2.2% to 3.2%, suggesting the circulation of an additional undescribed flavivirus prior to the introduction of WNV into the area. Flavivirus prevalence as determined by iELISA increased in 2002 and 2003 (23.3% and 31.9%, respectively). The increase in prevalence exceeded estimates of WNV prevalence, suggesting that conditions favored general flavivirus transmission (including WNV) during the 2002-2003 epizootic. These data indicate that serologic analysis of deer sera collected from hunter harvests may prove useful for surveillance and evidence of local transmission of WNV and other pathogens and identify white-tailed deer as a species for further studies for host competency.

Animals↗
PubMed2006

Mumps epidemic--Iowa, 2006.

In the United States, since 2001, an average of 265 mumps cases (range: 231-293 cases) have been reported each year, and in Iowa, an average of five cases have been reported annually since 1996. However, in 2006, by March 28, a total of 219 mumps cases had been reported in Iowa, and an additional 14 persons with clinically compatible symptoms were being investigated in three neighboring states (11 in Illinois, two in Nebraska, and one in Minnesota) in what has become the largest epidemic of mumps in the United States since 1988. This report summarizes and characterizes the ongoing mumps epidemic in Iowa, the public health response, and recommendations for preventing further transmission.

Adolescent↗
PubMedDate not supplied

A survey of health needs of older adults in northwest Johnson County, Iowa.

In 1975, the 1972 survey by the DuPage County, Illinois, Health Department (Managan et al. 1974) was replicated in an eight-township area of Johnson County, Iowa, to compare and document areas of nursing needs for the nursing division of a rural health center and to determine if the Illinois findings were generalizable to a setting which included both similarities and differences. The DuPage County population was urban, while the Johnson County population had a strong farm background and the majority of the subjects still resided on a farm. The DuPage County sample of 1,466 represented approximately 5 percent of the elderly population. The sample size in the Johnson County study was only 82; however, it represented approximately 10 percent of the elderly in the eight townships of the study area. The method of interviewing in the resident's homes was replicated as was DuPage's method of statistical analysis. Comparison of data from the two counties showed striking similarities in all parameters: health condition, physical functioning accessibility of medical care, social isolation, and service needs. Both studies found need for additional health services. A multiple disciplinary service approach to health needs would assist the elderly to remain in their own homes longer and to improve the quality of their lives. In the Iowa study, four questions to determine satisfaction with present living facilities and with adequacy of income for needed medical and dental costs were added. When these answers were compared to two previous Iowa studies, findings were similar.

Aged↗
PubMed1986

The status and future of small maternity services in Iowa.

Small Iowa community hospitals (fewer than 500 deliveries annually) are currently the site of approximately 37% of hospital births in the state. Many of these facilities face severe financial constraints aggravated by reduced Medicare payments and diagnosis-related group payment mechanisms. The quality and quantity of services provided by small hospitals are illustrated by birth and mortality data for the period that spans the development of Iowa's regionalized perinatal care system. Small hospitals appear to compare very favorably when matched with their larger level I counterparts with regard to neonatal mortality rates, incidence of births of very-low-birth-weight neonates, survival of very-low-birth-weight neonates, occurrence of neonatal deaths relative to the total birth population, and incidence of neonatal morbidities. Because these hospitals provide valuable services in Iowa's perinatal care system, their closure may seriously compromise perinatal health care for rural Iowans.

Birth Rate↗
PubMed1985

Bovine thelaziasis in Iowa.

The prevalence of developing Thelazia nematodes in face flies (Musca autumnalis) was studied for 7 yr at a beef farm in central Iowa. Juvenile nematodes were not found among flies in reproductive diapause in autumn, nor among nulliparous, overwintered flies in spring, but only among actively reproducing insects. Thus Thelazia probably do not overwinter in face flies. A mean prevalence of 2.0% infected was recorded among flies in 7 fly breeding seasons. No heterogeneity in Thelazia prevalence was detected within fly breeding seasons. The frequency distribution of Thelazia among face flies by year of occurrence was homogeneous, with a mean of 2.75 larval nematodes per infected fly. Thelazia gulosa and T. skrjabini were recovered in necropsy from the eyes of bovines from central Iowa. Prevalence among fat cattle 18-27 mo old was 15%; among cows 3-15 yr old, prevalence was only 3%. Thelazia skrjabini was found in 29 eyes and T. gulosa in 4 eyes. Infections were randomly distributed among the eyes of subject cattle. The mean worm burden was 2.3 T. skrjabini and 12 T. gulosa per infected eye. Thelaziasis is clearly enzootic in Iowa.

Animals↗
PubMed1981

Cancer mortality in Iowa farmers, 1971-78.

Age-adjusted cancer mortality rates from 1971 to 1978 for male farmers and nonfarmers were computed from Iowa death certificate information. Only data for white males were included in the study because of the limited number of nonwhite farmers in Iowa and because of incomplete occupational information available on females. Mortalities from major types of cancer for farmers and nonfarmers were compared by means of proportionate mortality ratios (PMR). The combined mortality rate for all types of cancer was significantly lower for farmers (PMR = 0.97), due primarily to the significantly lower rates for smoking-related cancers: lung, PMR = 0.78; esophagus, PMR = 0.74; mouth other than lip, PMR = 0.82; and other respiratory cancers, PMR = 0.65. However, the mortality rates for the following cancers were significantly higher for farmers: lip, PMR = 1.62; stomach, PMR = 1.14; leukemia, PMR = 1.10; lymphatic, PMR = 1.14; multiple myeloma, PMR = 1.27; and prostate, PMR = 1.10. Each of the six types of cancer with a significantly elevated mortality in Iowa farmers has also been reported as having an elevated mortality in farmers in other states.

Adult↗
PubMedDate not supplied

Outbreak of Mycoplasma iowae infection in commercial turkey poults.

In September 1989, 17-day-old turkey poults were submitted to Iowa State University because of leg weakness and dehydration. These birds were commercial large white toms from a flock of 23,214. Lesions observed at necropsy included chondrodystrophy of the hock joints, clear fluid in hock joint spaces, valgus deformities and shortening of the tarsometatarsal bones, and curled toes. Mycoplasma iowae was isolated and identified from swabs of the air sac, cloaca, hock joint, and large intestine. Approximately 1.4% of the flock was culled between 2 and 8 weeks of age because of leg problems. M. iowae infection did not severely affect overall flock performance. Eighty-seven percent of the flock was marketed at 18 weeks of age with an average per turkey weight of 29.5 pounds.

Animals↗
PubMed1993

Parelaphostrongylus tenuis (Nematoda) in white-tailed deer (Odocoileus virginianus) in central Iowa.

Heads of hunter-killed white-tailed deer (Odocoileus virginianus) were obtained from a tri-county area in central Iowa in December 1991 and examined for the presence of Parelaphostrongylus tenuis (Dougherty, 1945). Adults of P. tenuis were found in 45% of 42 deer heads; the mean intensity of infection was 3.6 (range: 1-16). Prevalence of infection was significantly greater in female deer > 13 mo of age in comparison to males of similar age (54 vs. 17%). Mean intensity of infection was significantly greater in deer > 13 mo of age than in younger deer (4.4 vs. 1.2 nematodes/head). Both prevalence and intensity of P. tenuis infection in deer in Iowa were comparable to levels reported elsewhere in the United States and Canada. These results further define the distribution of P. tenuis and suggest that susceptible hosts sharing habitat with white-tailed deer in Iowa are at risk of infection with this parasite.

Animals↗
PubMed1993

Massasauga rattlesnake bites in Iowa.

Historically, bites from swamp rattlesnakes in Iowa have been mild, but a bite in eastern Iowa in 1990 produced life threatening thrombocytopenia. Only four populations of massasauga rattlesnakes have been verified in Iowa.

Adolescent↗
PubMed1995

Geographic variation in primary care visits in Iowa.

OBJECTIVE: This study investigates the determinants of primary care office visit rates. DATA SOURCES: Blue Cross and Blue Shield of Iowa subscriber information was sorted by residence into geographic health service areas. Cost-sharing information was also obtained from Blue Cross. Physician supply data were obtained from The University of Iowa, Office of Community-Based Programs. Hospital data were reported by the Iowa Hospital Association. STUDY DESIGN: Cases were classified into ambulatory care groups (ACGs). Use rates were computed for each group in each service area. Ordinary least squares regression models were developed to model geographic variation in each ACG-specific primary care visit rate. PRINCIPAL FINDINGS: Regression models were not significant for five out of eleven ACGs studied. Out-of-pocket expense significantly affected utilization in three out of six. The number of primary care practices per capita had a significant effect on utilization in two ACGs. The supply of hospital outpatient services was significant in one ACG. CONCLUSIONS: Study findings reveal that some ACGs are price-sensitive and some are not. Policies aimed at changing levels of primary care use should taken into account whether varying cost-sharing will influence consumer behavior in the desired direction.

Adult↗
PubMedDate not supplied

Career promotional activities of Iowa dental hygienists.

PURPOSE: The purpose of this research was to investigate the relationship between Iowa dental hygienists' career promotional behaviors and (1) attitudes about career satisfaction, (2) beliefs about the job market, (3) membership in the American Dental Hygienists' Association, (4) demographics, and (5) employment characteristics. METHODS: In February 1993, questionnaires were mailed to a stratified random sample of 467 Iowa dental hygienists licensed and residing in the state of Iowa. Participation in four career promotional behaviors was ascertained as well as several independent variables. The data were analyzed with frequency distributions, Pearson's correlation coefficients, and chi-square statistics. RESULTS: An adjusted response rate of 92.3% was achieved (N=423 respondents). The majority of respondents (79.1%) recommended a career in dental hygiene, but fewer than 20% participated in a dental hygiene career day, gave an undesignated monetary gift to a dental hygiene education program, or donated to a dental hygiene scholarship fund. The independent variables were not related consistently to each of the career promotional activities. CONCLUSIONS: It appears that career promotional behaviors are multifaceted and require additional research to elucidate the interrelationships and enhance coordinated approaches to dental hygiene career recruitment.

Adult↗
PubMedDate not supplied

Utilization of dental services by Iowa Medicaid-enrolled children younger than 6 years old.

All Medicaid-enrolled children are eligible to receive dental care through the Early and Periodic Screening, Diagnostic and Treatment Program (EPSDT). As part of an evaluation of the effectiveness of the EPSDT program in Iowa, Medicaid enrollment and claims files from fiscal year (FY) 1994 were used to evaluate the utilization of dental services by Medicaid-enrolled children younger than age 6 during FY 1994. During FY 1994, 23% of Medicaid-enrolled children younger than age 6 received at least one dental service while enrolled in the Medicaid program. The total Medicaid-allowed charges for all dental services provided to this population while enrolled in Medicaid during FY 1994 was $1.53 million (the amount Medicaid would pay for the service, prior to calculating any copayments or other insurance charges). Although the EPSDT program in Iowa requires a referral of all Medicaid-enrolled children to a dentist at 1 year of age, fewer than 4% of enrolled children in this age group received any dental services. The percent of enrolled children receiving a dental exam during FY 1994, by age, was as follows: younger than 1 year, 0.2%; age 1, 3%; age 2, 10%; age 3, 27%; age 4, 46%; age 5, 54%. Utilization rates of dental services by Medicaid-enrolled children in Iowa fall far short of federal regulations, which currently require that 80% of enrollees receive EPSDT screenings, referrals, and treatment by age 3.

Age Factors↗
PubMed1995

Ischemic stroke in young adults. Experience in 329 patients enrolled in the Iowa Registry of stroke in young adults.

OBJECTIVES: To describe the likely causes of ischemic stroke in a population of young adults and to report the influence of strict algorithms on the diagnosis of the likely cause of stroke in this cohort. DESIGN: Between July 1, 1977, and January 1, 1993, we registered 329 young adults with ischemic stroke in our registry. Diagnostic studies were selected on a case-by-case basis. Presumed causes of stroke were determined using clinical information and the results of diagnostic tests. In each case, a second causative diagnosis was made using the criteria developed for a large clinical trial. SETTING: Patients referred to the Division of Cerebrovascular Diseases in the Department of Neurology at the University of Iowa Hospitals and Clinics, Iowa City, by physicians in Iowa and adjacent states. PATIENTS: Three hundred twenty-nine young adults (182 men and 147 women) aged 15 to 45 years with ischemic stroke; 102 persons, 48 men and 54 women, were aged 30 years or younger. RESULTS: Cerebral arteriography was performed in 227 cases, and the findings were abnormal in 146. Transthoracic echocardiography revealed abnormalities in 82 of 221 patients examined. We identified approximately 60 different disorders that were presumed to be the cause of stroke. There were no major changes in the frequency of subtype diagnoses between the first 144 patients and the subsequent 185. Use of strict diagnostic criteria increased the number of cases of stroke of undetermined etiology (from 45 to 113), and the number attributed to large artery atherosclerosis declined from 71 to 32. CONCLUSIONS: The causes of ischemic stroke in young adults are numerous. Because treatment options in this group are influenced by a presumed cause, an evaluation on a case-by-case basis is warranted. Our experience suggests that a likely cause will be detected in most cases and that a regimented battery of tests may not be required. If strict diagnostic criteria are used, the diagnosis of stroke of undetermined etiology considerably increases. While such strict criteria are important in clinical trials that test new interventions, the value of the application of such methodologies to an unusual population, such as stroke in young adults, needs clarification. In particular, the usefulness of categorizing a stroke as undetermined when two or more possible causes are identified needs to be explored.

Adolescent↗
PubMed1994

Comparison of antigenic and pathogenic properties of Mycoplasma iowae strains and development of a PCR-based detection assay.

The six reference strains of Mycoplasma iowae (I, J, K, N, Q and R) and 12 field strains, most of them isolated from turkeys, were studied with a growth-inhibition test and a dot immunobinding test with rabbit antisera to the different serovars of M iowae, 16S rDNA gene amplification by polymerase chain reaction, and pathogenicity for chicken or turkey embryos. Antigenic tests tended to be strain specific and showed that most field strains were closely related to serovars K or N. The two pairs of primers chosen in 16S rDNA guided the amplification of 332 base pairs (bp) or 892 bp fragments from all the M iowae strains tested. All the field strains tested were highly pathogenic for turkey embryos.

Animals↗
PubMed2005

Emotion-based learning and central executive resources: an investigation of intuition and the Iowa Gambling Task.

The role of emotion in complex decision-making can be assessed on the Iowa Gambling Task (IGT), a widely used neuropsychological measure that may tap a different aspect of executive function than that assessed by conventional measures. Most notably, the 'feeling' about which decks are good or bad, often described in relation to IGT performance, seems reminiscent of decision-making based on intuition-linked to a long history of research in decision-making contrasting the 'intuition' versus 'reasoning' styles of problem solving. To test the claim that the performance on the IGT relies more on emotion-based learning than conventional executive resources for normal performance, a group of participants completed the IGT simultaneously with one of two secondary-tasks, one of which (random number generation) is known to load executive resources. A third group performed the IGT with no secondary-task. If performance on the IGT requires the properties associated with intuitive operations, then participants should either show no disruption when completing a secondary-task, or at least show no selective disruption on a secondary-task that loads for executive function. The rate of learning in the three groups was not significantly different. This suggests that the sorts of cognitive resources loaded by traditional executive tasks such as random number generation do not overlap, in the cognitive architecture, with the emotion-based learning skills that are required for Iowa Gambling Task performance. The findings of the present study are also consistent with a previous claim of the Iowa group that emotion-based learning and working memory resources are doubly dissociable.

Cognition↗