Improving rural health care in South Dakota

This study was designed to find ways to improve the quality of health care in rural settings. The study includes three components: a telephone survey of a rural community, a patient quiz, and interviews with ten rural family practice doctors in the southeast corner of South Dakota. This study was conducted in a rural community of about 1,500 people. The results of the survey suggest that rural health care can be improved by more education of the public on what is offered for preventative medicine, especially for the men 55 or younger, a female doctor who is willing to do obstetrical/gynecological services to meet the local demand, and physicians learning new procedures such as colonoscopy, colposcopy, and stress testing to better serve their patients.     

Rural health care networks in South Dakota

To address health care access concerns, a Regional Coordinated Care Network (RCCN) program, through Robert Wood Johnson Foundation Practice Sights Initiative funding, is being developed by the South Dakota Office of Rural Health. The intent of the initiative is to expand primary and preventive care and, hopefully, permanently reduce the number of Health Professional Shortage Areas (HPSAs) in the state by linking and enhancing providers and services. In rural areas such networking will be crucial for the delivery of health care. Surely, the impact on family physicians will be significant and salutary.     

Combination Subsurface Irrigation and Drainage Systems in North-Central South Dakota

The 340,000 ha Lake Dakota Plain area in north-central South Dakota has the topographical and soil characteristics required for the use of combination subsurface drainage and irrigation systems. Corn yield data from a research site and a county-wide reporting service were used to determine that DRAINMOD, a water balance and corn yield estimation computer model, could be employed to assess the feasibility of using a combination system for the area. Three soils ranging in texture from a sandy loam to a silt loam and 19 years of climatic data were used in the feasibility analysis. Drain line spacings were determined for average yield goals of 90, 95, and 100% of estimated maximum corn yields for each soil. There are possibilities for the economical use of combination subsurface irrigation and drainage systems in the Lake Dakota Plain area.     

Diabetes research in South Carolina: past, present, and future

Medical investigators in South Carolina have been on the "cutting edge" of diabetes research for a number of decades. Despite this fact, our state ranks second in the nation in diabetes prevalence, and diabetes complications are more severe here than anywhere else. It is from the efforts of these investigators that our hope for a brighter future comes. Through a concerted effort toward prevention, improvements in care, and investigation of the pathophysiology of diabetes and its complications, researchers may reduce the substantial burden of diabetes in our state and throughout the world.     

Diabetes microvascular complications in prepubertal children

In the light of recent experiences and anticipating an increase in similar requests in the future, it seemed very interesting to a drug safety executives' group from the pharmaceutical industry to propose guidelines for the set-up and follow-up of pharmacoepidemiological studies requested by Health Authorities for the assessment of drug risk. The scope of these guidelines is to establish the responsibility of the teams and structures involved in the study, to define the necessary stages set-up, and to determine the rules in order to ensure its smooth running from the drafting of the protocole to the final use of the data.     

Heart transplantation in Lincoln, Nebraska: the Nebraska Heart Transplant Program experience

The results of the Nebraska Heart Transplant Program are presented. Survival at one and four years, cost, waiting time and return to work rates are reported and compared to known standards. Survival is 91 percent at one year and 76 percent at four years after transplant. These data as well as costs, waiting time and return to work compare favorably with published and reported data. We conclude the results of the Nebraska Heart Transplant Program by all parameters evaluated are excellent. Referral of patients to distant programs causes needles inconvenience and higher patient costs, and is not justified.     

Perspectives on the diagnosis, epizootiology, and control of the 1973 duck plague epizootic in wild waterfowl at Lake Andes, South Dakota

An epizootic of duck plague occurred in early 1973 in a population of 163,500 wild waterfowl, primarily mallards (Anas platyrhynchos), wintering on Lake Andes and the nearby Missouri River in southeastern South Dakota (USA). The diagnosis was based on pathologic lesions and confirmed by virus isolation. Control measures included quarantine, attempts to reduce virus contamination of the area, dispersal of waterfowl, and monitoring of wild waterfowl populations for mortality. The epizootic resulted in documented mortality of 18% and estimated mortality of 26% of the waterfowl at risk. Prompt implementation of control measures might have limited mortality to approximately 8%. Losses during the epizootic were equivalent to 0.12% of the annual mortality in the North American 1996 fall population of 80,000,000 wild ducks. The most likely sources of the infection were free-flying wild mallard or American black duck (Anas rubripes) carriers from the upper midwestern or northeastern United States. Duck plague serum neutralization antibodies were demonstrated in 31% of 395 apparently healthy mallards sampled prior to dispersal of the flock at Lake Andes, suggesting that tens of thousands of potential duck plague carriers entered the wild waterfowl populations of all four major flyways. Consequently, the absence of major epizootics of duck plague in wild waterfowl in the subsequent two decades is evidence that substantial numbers of duck plague carriers can occur in wild waterfowl populations without resulting in epizootic mortalities. The failure to isolate duck plague virus from apparently healthy mallards sampled during the epizootic raises questions concerning the validity of conclusions regarding the status of duck plague in wild waterfowl based upon negative results of random surveys conducted in the absence of epizootics.     

Flow Velocity and Pier Scour Prediction in a Compound Channel: Big Sioux River Bridge at Flandreau, South Dakota

The two-dimensional (2D) depth-averaged river model Finite-Element Surface-Water Modeling System (FESWMS) was used to predict flow distribution at the bend of a compound channel. The site studied was the Highway 13 bridge over the Big Sioux River in Flandreau, South Dakota. The Flandreau site has complex channel and floodplain geometry that produces unique flow conditions at the bridge crossing. The 2D model was calibrated using flow measurements obtained during two floods in 1993. The calibrated model was used to examine the hydraulic and geomorphic factors that affect the main channel and floodplain flows and the flow interactions between the two portions. A one-dimensional (1D) flow model of the bridge site was also created in Hydrologic Engineering Centers River Analysis System (HEC-RAS) for comparison. Soil samples were collected from the bridge site and tested in an erosion function apparatus (EFA) to determine the critical shear stress and erosion rate constant. The results of EFA testing and 2D flow modeling were used as inputs to the Scour Rate in Cohesive Soils (SRICOS) method to predict local scour at the northern and southernmost piers. The sensitivity of predicted scour depth to the hydraulic and soil parameters was examined. The predicted scour depth was very sensitive to the approach-flow velocity and critical shear stress. Overall, this study has provided a better understanding of 2D flow effects in compound channels and an overall assessment of the SRICOS method for prediction of bridge pier scour.     

Diabetes mellitus and major depressive disorder: an overview of prevalence, complications, and treatment

Economic forces, policy initiatives, and technological change push markets along what some hypothesize is a common evolutionary path. Observations from twelve sites, however, indicate that the pace and direction of change are highly variable across markets. Other forces, internal and unique to a community, help to explain this variation. These forces emanate from the underlying history, culture, and values of a community and in part dictate the response of various players to the more common forces. This paper explores the mechanisms through which these forces operate and their relationship to health system change.     

Identifying Critical Sources of Bridge Deterioration in Cold Regions through the Constructed Bridges in North Dakota

This paper presents the performance of constructed bridges in cold regions through examining the bridges in North Dakota that is one of the coldest regions in the United States. Unique approach of a combined multiple regression and geographic information system technology is employed to evaluate the performance and to identify the critical sources affecting deterioration of the 5,289 bridges sampled from the National Bridge Inventory database inspected between 2006 and 2007. Typical parameters examined include physical, material, and environmental factors associated with the existing bridges. The importance of maintenance and repair is highlighted. Traffic volume significantly influences the level of deterioration of the bridge decks. Year built is the most significant contribution to the structural deficiency of the bridges, followed by structural characteristics and traffic volumes. The presence of water particularly influences the deterioration. Concrete bridges are more durable than steel bridges. Truss systems may not be recommended for cold regions.     

Diabetes mellitus in Egypt: glycaemic control and microvascular and neuropathic complications

We performed a cross-sectional, population-based survey of persons 20 years of age and older living in Cairo and surrounding rural villages. The purpose was to describe glycaemic control and the prevalence of microvascular and neuropathic complications among Egyptians with diagnosed diabetes, previously undiagnosed diabetes, impaired glucose tolerance, and normal glucose tolerance. A total of 6052 households were surveyed. The response rate was 76% for the household survey and 72% for the medical examination. Among people with previously diagnosed diabetes, mean haemoglobin A1c, was 9.0%. Forty-two per cent had retinopathy, 21% albuminuria, and 22% neuropathy. Legal blindness was prevalent (5%) but clinical nephropathy (7%) and foot ulcers (1%) were uncommon in persons with diagnosed diabetes. Among people with diagnosed diabetes, microvascular and neuropathic complications were associated with hyperglycaemia. Retinopathy was also associated with duration of diabetes; albuminuria with hypertension and hypercholesterolaemia; and neuropathy with age, female sex, and hypercholesterolaemia. Albuminuria was as common in people with previously undiagnosed diabetes (22%) as those with diagnosed disease (21%). Mean haemoglobin A1c was lower (7.8%) and retinopathy (16%) and neuropathy (14%) were less prevalent in people with previously undiagnosed disease. Ocular conditions, blindness, and neuropathy were prevalent in the non-diabetic population. The microvascular and neuropathic complications of diabetes are a major clinical and public health problem in Egypt.     

Pregnancy and oral health: utilization of the oral health care system by pregnant women in North Dakota

There is little data on the oral health of pregnant women in North Dakota. In response, the Dental Program of the North Dakota Department of Health included two oral health questions on a survey sent to 2,250 new mothers in the state. The oral health questions were designed to gather information on the proportion of pregnant women using the oral health care system and to identify major barriers to receiving oral health care services. The survey response rate was 65 percent. Just under half of the women responding (43.2%) had visited the dentist during their pregnancy. The major reason cited for not visiting the dentist was that they were not having any problems. There appears to be a lack of knowledge regarding the need for this particular aspect of prenatal care.     

Venous disease and its complications

The major focus of preventive medicine in the aged must be on the clinical consequences of peripheral arteriosclerosis rather than the disease process itself. Treating risk factors may be of some limited benefit. However, of most crucial importance is careful attention to premonitory symptoms and the state of the peripheral pulses including the abdominal aorta.