State of South Dakota's Child: 2023.

In 2022, there was a decrease in births in the state with 111 fewer resident newborns than in the previous year. This represented a decrease of 1% of its white and 3.5% of its AIBO (American Indian, Black and Other) births. The 2022 birth rate per 1,000 population for the state (12.3) is higher than observed nationally (10.9) but matches its 2020 rate that was an historic low. Approximately 22% of all births in 2022 were AIBO and this percent of the state's entire birth cohort has decreased in the past several years. The American Indian contribution to the AIBO cohort has also decreased as its racial diversity has increased. The percent of births that are low birth weight has consistently been lower in South Dakota than nationally. An increase of 16 infant deaths in 2022 from 2021 and the decreased number of births led to an increase in the infant mortality rate (IMR = deaths in first year of life per 1,000 live births) from 6.3 to 7.8, but this 2022 IMR is not statistically significantly higher than its previous five-year mean. Further, the 2022 increase in the IMR was almost entirely among white infants with the post neonatal mortality rate (PNMR = deaths between 28 and 365 days of life) decreasing between these two years for AIBO infants. Nonetheless, the state's five year mean rates of death (2018-2022) are significantly higher for the AIBO than white infants for the neonatal (0-27 days) and post neonatal periods of the first year of life. Recently, however, the ratio of AIBO to white post neonatal mortality rate (PNMR) has decreased, but increased for the neonatal mortality rate (NMR). Infants in South Dakota are significantly more likely between 2018 and 2022 to die of congenital anomalies, sudden unexpected infant death (SUID), and accidents/homicides than in the United States in 2021. SUID remains the leading cause of post neonatal death and its risk may be decreased when babies are placed to sleep supine and alone in environments that are devoid of soft hazards.

Mortality Disparities Among Arrestees by Race, Sentencing Disposition, and Place.

Importance: Understanding mortality disparities among justice system-involved populations is crucial for public health and policy, especially for marginalized racial groups such as American Indian/Alaska Native persons. Objective: To examine racial disparities in mortality within the broader justice system-involved population in South Dakota, focusing on different sentencing dispositions and the role of place. Design, Setting, and Participants: This observational study used administrative criminal records linked to mortality data from January 2000 to December 2016. The statewide data linked data from South Dakota Attorney General's Office and South Dakota Department of Health. Individuals aged 18 years and older with arrests were analyzed in this population-based sample. Data were analyzed from August 1, 2022, to July 30, 2023. Exposure: Sentencing dispositions were categorized as arrest only, fine, probation, jail, and prison. Main Outcomes and Measures: The main outcomes were mortality rates (both all-cause and cause-specific) calculated using Poisson regression models, adjusted for demographic and county variables. Results: Of 182 472 individuals with 422 987 arrests, the study sample included 29 690 American Indian/Alaska Native arrestees (17 900 [60%] male; mean [SD] age, 29.4 [11.0] years) and 142 248 White arrestees (103 471 [73%] male; mean [SD] age, 32.6 [12.9] years). American Indian/Alaska Native persons accounted for 16% of arrestees and 26% of arrests, but only 9% of the population in South Dakota. Across dispositions, mortality risk was greater for White individuals sentenced to probation, jail, and prison relative to White individuals who were arrested only. In terms of racial disparities, all-cause mortality risk was 2.37 (95% CI, 1.95-2.88) times higher for American Indian/Alaska Native than White arrestees in the arrest-only disposition. Disparities persisted across all dispositions but narrowed substantially for probation and prison. Results were similar for cause-specific mortality risk, except for cancer risk. In urban areas, mortality risk was 2.70 (95% CI, 1.29-2.44) times greater for American Indian/Alaska Native individuals relative to White individuals among those with arrest-only dispositions. Conclusions and Relevance: In this population-based observational study, mortality risk and associated racial disparities among justice system-involved individuals differed substantially across dispositions and places, underscoring the need for public health interventions tailored to these factors. Further research is needed to understand the mechanisms through which sentencing and place shape these disparities.

The Epidemic of Congenital Syphilis in the Indigenous and Rural Populations of South Dakota.

From 2020 to 2023, South Dakota witnessed a substantial increase in cases of congenital syphilis (CS), with the highest rates identified in rural and Native American (NA) communities. Here, we discuss 3 severe cases of CS in premature infants born to NA individuals and communities in South Dakota with poor access to prenatal care. The infants in these 3 cases presented with varying clinical conditions, including respiratory failure, persistent pulmonary hypertension of the newborn, severe direct hyperbilirubinemia, feeding intolerance, and necrotizing enterocolitis. Lack of prenatal care and other systemic health disparities likely contributed to the increased disease burden. For NA communities, rurality, limited resources, systemic racism, historical trauma, and lack of trust in medical institutions likely contribute to inadequate prenatal care. All 3 of these cases also occurred in pregnant people with a present or history of substance use disorders, which may have led to further hesitancy to seek care because of fear of prosecution. To combat the rising number of syphilis and CS cases, we advocate for new and continued outreach that provides education about and testing for sexually transmitted diseases to NA and rural populations, increased care coordination, the integration of point-of-care testing and treatment strategies in lower resource centers, and legislative allocation of additional resources to engage pregnant people with or at risk for substance use disorders.

Outbreak of Human Trichinellosis - Arizona, Minnesota, and South Dakota, 2022.

Trichinellosis is a parasitic zoonotic disease transmitted through the consumption of meat from animals infected with Trichinella spp. nematodes. In North America, human trichinellosis is rare and is most commonly acquired through consumption of wild game meat. In July 2022, a hospitalized patient with suspected trichinellosis was reported to the Minnesota Department of Health. One week before symptom onset, the patient and eight other persons shared a meal that included bear meat that had been frozen for 45 days before being grilled and served rare with vegetables that had been cooked with the meat. Investigation identified six trichinellosis cases, including two in persons who consumed only the vegetables. Motile Trichinella larvae were found in remaining bear meat that had been frozen for >15 weeks. Molecular testing identified larvae from the bear meat as Trichinella nativa, a freeze-resistant species. Persons who consume meat from wild game animals should be aware that that adequate cooking is the only reliable way to kill Trichinella parasites and that infected meat can cross-contaminate other foods.

Patterns of Hemorrhagic Disease in White-Tailed Deer (Odocoileus virginianus) in the Great Plains of the USA, 1982-2020.

Hemorrhagic disease (HD) of deer is caused by epizootic hemorrhagic disease virus (EHDV) or bluetongue virus (BTV) and is considered one of the most important viral diseases of white-tailed deer (Odocoileus virginianus). Despite evidence of changing patterns of HD in the northeastern and upper midwestern US, the historical and current patterns of HD in the Great Plains remain poorly described. We used results from an annual survey documenting HD mortality to characterize historic and current patterns of HD in the northern and central Great Plains (North Dakota, South Dakota, Nebraska, Kansas, and Oklahoma), US, between 1982 and 2020. Further, we assessed temporal change using linear regression to determine change in annual reporting intensity (percentage of counties in a state with reported HD) and change in reporting frequency (the number of years a county or state reported HD) during each decade between 1982 and 2020. Across the 38-yr study period, HD reports expanded northeast across latitude and longitude. Intensity of HD reports significantly increased during this period for three (North Dakota, South Dakota, Kansas) of five states examined. Frequency of reports also increased for all five states. Such changes in northern latitudes might lead to increased deer mortality in regions where HD epizootics have been historically less frequent. Understanding how patterns of HD are changing on the landscape is important when considering future deer management in the face of other mortality factors.

Changes in Patterns of Trauma Injuries in the Dakotas Region During the COVID-19 Pandemic.

BACKGROUND: The aim of this study is to compare impact of COVID-19 on trauma volume and characteristics on a set of trauma centers with a rural catchment area. The COVID-19 pandemic has affected different parts of the country quite differently, both in case volume and in local responses. State-wide responses have varied considerably, including variations in local mask mandates, school closures, and social distancing measures. METHODS: This was a retrospective trauma registry review of patients who were admitted to three of the tertiary care trauma centers in North and South Dakota between 2014 through 2022. RESULTS: In the analysis of 36,397 patients, we found a significant increase in trauma patient volume during the COVID-19 pandemic, with an increased percentage of patients presenting with a mechanism of injury secondary to abuse or assault. This increase in patient volume continued to rise during 2021 and 2022. CONCLUSIONS: Our study demonstrates how the COVID-19 pandemic impacted trauma center admissions in the rural and frontier Midwest differently from more urban areas, and the importance of including a variety of settings in trauma research.

Sensitivity of US Preventive Services Task Force and PLCOm2012 lung cancer screening eligibility criteria in individuals with lung cancer in South Dakota self-reporting as Indigenous and non-Indigenous.

BACKGROUND: Lung cancer is the leading cause of cancer deaths. Screening individuals who are at elevated risk using low-dose computed tomography reduces lung cancer mortality by ≥20%. Individuals who have community-based factors that contribute to an increased risk of developing lung cancer have high lung cancer rates and are diagnosed at younger ages. In this study of lung cancer in South Dakota, the authors compared the sensitivity of screening eligibility criteria for self-reported Indigenous race and evaluated the need for screening at younger ages. METHODS: US Preventive Services Task Force (USPSTF) 2013 and 2021 (USPSTF2013 and USPSTF2021) criteria and two versions of the PLCOm2012 risk-prediction model (based on the 2012 Prostate, Lung, Colorectal, and Ovarian [PLCO] Cancer Screening Trial), one with a predictor for race and one without, were applied at USPSTF-equivalent thresholds of ≥1.7% in 6 years and ≥1.0% in 6 years to 1565 individuals who were sequentially diagnosed with lung cancer (of whom 12.7% self-reported as Indigenous) at the Monument Health Cancer Care Institute in South Dakota (2010-2019). RESULTS: Eligibility sensitivities of USPSTF criteria did not differ significantly between individuals who self-reported their race as Indigenous and those who did not (p > .05). Sensitivities of both PLCOm2012 models were significantly higher than comparable USPSTF criteria. The sensitivity of USPSTF2021 criteria was 66.1% and, for comparable PLCOm2012 models with and without race, sensitivity was 90.7% and 89.6%, respectively (both p < .001); 1.4% of individuals were younger than 50 years, and proportions did not differ by Indigenous classification (p = .518). CONCLUSIONS: Disparities in screening eligibility were not observed for individuals who self-reported their race as Indigenous. USPSTF criteria had lower sensitivities for lung cancer eligibility. Both PLCOm2012 models had high sensitivities, with higher sensitivity for the model that included race. The PLCOm2012noRace model selected effectively in this population, and screening individuals younger than 50 years did not appear to be justified. PLAIN LANGUAGE SUMMARY: Lung cancer is the leading cause of cancer deaths. Studies show that using low-dose computed tomography scans to screen people who smoke or who used to smoke and are at elevated risk for lung cancer reduces lung cancer deaths. This study of 1565 individuals with lung cancer in South Dakota compared screening eligibility using US Preventive Services Task Force (USPSTF) criteria and a lung cancer risk-prediction model (PLCOm2012; from the 2012 Prostate, Lung, Colorectal, and Ovarian [PLCO] Cancer Screening Trial). The model had higher sensitivity and picked more people with lung cancer to screen compared with USPSTF criteria. Eligibility sensitivities were similar for individuals who self-reported as Indigenous versus those who did not between USPSTF criteria and the model.

The Relationship of Modified Rankin Score and Risk Factors with Stroke Mortality in the South Dakota Native American Population: A Descriptive Study.

OBJECTIVE: To describe the impact of multiple risk factors on stroke outcomes among Native Americans in South Dakota. METHODS: This is a retrospective chart review of 189 Native American patients treated for stroke in South Dakota between Jan. 1, 2016, to May 1, 2021 at a single hospital system. RESULTS: Risk factor prevalence in the population: hypertension (76.1%), smoking (74.2%), diabetes mellitus (56.8%), dyslipidemia (55.4%), alcohol use (43.7%), cardiac or vascular disease (39.7%), stroke history (26.4%), and atrial fibrillation (13.3%). There was no significant difference between admission and 90-day post-discharge modified Rankin scale scores in all patients. Five risk factors were significantly associated with death: older age, hemorrhagic stroke, female sex, atrial fibrillation, and cardiac/vascular disease. CONCLUSION: These results align with previous studies that concluded many stroke risk factors are more prevalent among Native Americans in comparison to other racial/ethnic groups. Therefore, it remains an imperative public health initiative that efforts be made to improve preventative measures which address comorbid conditions and behaviors in Native American populations to reduce risk for stroke with subsequent related disability or death.

The Relationship of Modified Rankin Score and Risk Factors with Stroke Mortality in the South Dakota American Indian Population: A Descriptive Study.

INTRODUCTION: To describe the impact of multiple risk factors on stroke outcomes among American Indians in South Dakota. METHODS: This is a retrospective chart review of 189 American Indian patients treated for stroke in South Dakota between Jan 1, 2016, to May 1, 2021, at a single hospital system. RESULTS: Risk factor prevalence in the population: hypertension (76.1%), smoking (74.2%), diabetes mellitus (56.8%), dyslipidemia (55.4%), alcohol use (43.7%), cardiac or vascular disease (39.7%), stroke history (26.4%), and atrial fibrillation (13.3%). There was no significant difference between admission and 90-day post-discharge modified Rankin scale scores in all patients. Five risk factors were significantly associated with death: older age, hemorrhagic stroke, female sex, atrial fibrillation, and cardiac/vascular disease. CONCLUSIONS: These results align with previous studies that concluded many stroke risk factors are more prevalent among American Indians in comparison to other racial/ethnic groups. Therefore, it remains an imperative public health initiative that efforts be made to improve preventative measures which address comorbid conditions and behaviors in American Indian populations to reduce risk for stroke with subsequent related disability or death.

Burnout Among South Dakota-Licensed Physicians.

INTRODUCTION: Physician well-being is a topic of increasing attention nationwide. In collaboration with the South Dakota Board of Osteopathic and Medical Examiners and the South Dakota State Medical Association, we undertook an anonymous, web-based survey of all licensed physicians to assess the current baseline level of physician burnout. METHODS: The survey consisted of demographic questions and a single, validated burnout question that correlates with the lengthier Maslach Burnout Index. A link to take the survey was emailed to all licensees by the Board, and a single reminder email and link was sent two weeks later. The collector was open for 4 weeks from date of the initial invitation. Both quantitative and qualitative analyses were performed on the responses. RESULTS: There were 612 responses (10%). Overall 33.0% of responses were positive for burnout. Comparing subgroups divided by average work hours, practice size, community size, geographic location within the state, employment status, and specialty type, only those practicing primarily telemedicine demonstrated statistically significant lower prevalence of burnout (17%). Qualitative analysis identified themes that both increased risk and offered protection against burnout, including sense of control, availability of resources, relationships, and meaning in work. CONCLUSION: Burnout among physicians licensed by South Dakota is prevalent, though lower than the rate reported in most studies of physicians nationally. Apart from practicing primarily telemedicine, there was no correlation between burnout and practice characteristics, but provoking and palliating factors across practice types were identified that may offer potential areas for intervention to improve wellness.

Identifying the Use of Tanning Beds Among Undergraduate Students at South Dakota Universities and the Role of Providers: A Survey Analysis.

INTRODUCTION: Tanning bed use is common among young adults in the United States, and it contributes to over 400,000 cases of skin cancer annually. Many college students acknowledge the risk of skin cancer with tanning bed use, but this is not always a deterrent to the behavior. This study assesses the trends regarding tanning bed usage among university students and analyzes the role that primary care providers (PCPs) and dermatologists could play in reducing participation in this risky habit. METHODS: This study used a digital survey to assess the tanning bed usage trends and other aspects of skin health among undergraduate students at South Dakota universities. The survey was developed through interviews with dermatologists and public health professionals affiliated with the University of South Dakota. RESULTS: 321 students responded to the survey; 80% identified as female, 86% as Caucasian, and 93% were from the Midwest. 41% of respondents reported having previously used tanning beds. 46% of respondents reported never having seen a dermatologist for a skin check, and 42% indicated that their PCP does not perform a skin check during routine visits. When asked how a provider might influence participants to reconsider the use of tanning beds, responses included being presented statistics related to skin cancer and visualization of physical damage resulting from exposure to ultraviolet light. CONCLUSION: This study aims to better understand the prevalence of tanning bed usage among students at South Dakota universities. It also sought to better understand how providers can intervene to help reduce participation in this behavior. Given the risk associated with tanning bed exposure, our findings suggest that many students may be at increased risk of skin cancer from this behavior alone. This should encourage PCPs to consider incorporating skin checks into their examinations and provide preventative counseling recommendations to this population.

Substance Use Disorder in Adults with ADHD in South Dakota.

INTRODUCTION: Attention-deficit hyperactivity disorder (ADHD) increases the risk for multiple comorbid psychiatric disorders, such as substance use disorder. Comorbid ADHD and substance use disorder has been shown to increase the risk of adverse occupational, social, psychological, and physical outcomes. Because of the severe risks of substance use, it is useful to determine the relative comorbidity of ADHD among different types of substance use disorders. This study examined the prevalence of ADHD in residential addiction treatment as well as the relative prevalence of ADHD among mono-substance use, comorbid substance use (2 comorbid substance use disorders), and polysubstance use (3+ substance use disorders). METHODS: Participants were adults admitted to residential treatment of substance use disorder. Participants were asked to complete a Wender Utah ADHD rating scale to assess the presence of ADHD. A cutoff score of 46 was used to determine presence of ADHD in this rating assessment. Participants were also provided with an ADHD history questionnaire designed for this study to gather information on childhood ADHD diagnoses, substance use history, and early-life effects o f attention disorders. RESULTS: Using the Wender Utah assessment scores, 55 participants with substance use disorder demonstrated an ADHD prevalence of 45% (n=30). Of the study population, 20% (n=11) of participants being diagnosed in childhood and another 25% (n=14) having a positive Wender Utah questionnaire score for ADHD as adult patients without a childhood diagnosis. All participants who had a childhood diagnosis of ADHD had received treatment for this disorder. Polysubstance use disorder (n=21) had an ADHD prevalence of 62%. Alcohol use disorder (n=21) had an ADHD prevalence of 24%. Methamphetamine use disorder (n=4) had an ADHD prevalence of 75%. Participants with ADHD (either during childhood or adulthood) had a nearly significant increase in the prevalence of polysubstance use disorder as compared to participants without ADHD (p = 0.0542). CONCLUSIONS: ADHD and substance use disorder have notable comorbidity. This study, among similar studies, demonstrates a high prevalence of ADHD in populations with substance use disorder. The presence of ADHD in patients with substance use disorder may influence which substances those patients choose to use. The difference in patients treated for childhood ADHD and those having a diagnosis of ADHD demonstrates a deficit in effective childhood ADHD screening. As such, effective screening and prevention of substance use disorder in patients with ADHD may be a useful tool in reducing the risk of developing substance use disorder. Additionally, adequate treatment of ADHD could be considered useful in treating a contributing element of substance use disorder.

Health Challenges in South Dakota: Creation of Healthcare Provider Referral List for Special Olympic Athletes.

INTRODUCTION: Individuals with intellectual and developmental disabilities (IDD) face significant health challenges affecting their overall morbidity and mortality. Special Olympics is one of the largest non-profit organizations that focuses on the promotion of health and fitness for individuals with IDD (referred to as athletes) year-round. At the state level, Special Olympics South Dakota (SOSD) hosts an annual Summer Games where athletes are provided the opportunity to obtain free health screenings. If an area is identified as needing further attention, a referral is made for the athlete to obtain more in-depth care. The referral process often leads to difficulties for athletes, ranging from finding a healthcare provider (HCP) who is comfortable working with individuals with disabilities, to ensuring the acceptance of a wide range of health insurances (such as Medicaid). Obstacles to finding a HCP for a referral is what necessitates the need for a statewide HCP referral list. The purpose of this project is to increase the ease of accessibility to HCPs for individuals with IDD who are Special Olympics South Dakota athletes. METHODS: Data from Special Olympics and the CDC Disability and Health Data System (DHDS) was gathered to compare health outcomes between those with disabilities nationwide to those with disabilities in South Dakota. The referral list obtained HCPs via an online two-part survey. Survey 1 focused on demographic information on HCP and place of practice and Survey 2 focused on HCP training and professional work with those with IDD. The surveys were sent to individual providers via their respective professional state associations as well as through convenience sampling (relationship with Clinical Directors for SOSD). Survey 1 gathered 233 responses total, with 95 meeting completion criteria. Survey 2 offered to those 95 and gathered 66 responses total. RESULTS: Data on multiple health outcomes from the Special Olympics and CDC DHDS revealed individualized areas of concern with little overlap between the two datasets. Of the 95 HCPs added to the referral list (40% completion rate from Survey 1), the majority were localized to areas of higher population density in South Dakota (Sioux Falls and Rapid City areas). In Survey 2, 90% of HCPs indicated some level of training for working with individuals with IDD and 74% of responding HCPs were interested in obtaining further training. All HCPs that responded to Survey 2 had encounters with individuals with IDD in their current professional role, with 94% having 4 or more encounters. CONCLUSIONS: The Special Olympics South Dakota HCP referral list provides a direct method for SOSD athletes to find referral care. Currently, this is the only database of health care providers that is accessible to individuals with IDD that are members of SOSD. Geographically however, much of South Dakota is not represented on the current HCP referral list. While 90% of HCPs have training, 30% indicate not having received formal training on working with individuals with IDD during their professional training, also showcasing a need for HCPs to strive to limit potential gaps in care.

Unique SARS-CoV-2 Variants, Tourism Metrics, and B.1.2 Emergence in Early COVID-19 Pandemic: A Correlation Analysis in South Dakota.

The severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus, which is the source of the coronavirus disease 2019 (COVID-19), was declared a pandemic in the March of 2020. Travel and tourism were severely impacted as restrictions were imposed to help slow the disease spread, but some states took alternative approaches to travel restrictions. This study investigated the spread of COVID-19 in South Dakota during the early pandemic period to better understand how tourism affected the movement of the virus within the region. Sequences from the fall of 2020 were retrieved from public sources. CDC and other sources were used to determine infections, deaths, and tourism metrics during this time. The data were analyzed using correlation and logistic regression. This study found that the number of unique variants per month was positively correlated with hotel occupancy, but not with the number of cases or deaths. Interestingly, the emergence of the B.1.2 variant in South Dakota was positively correlated with increased case numbers and deaths. Data show that states with a shelter-in-place order were associated with a slower emergence of the B.1.2 variant compared to states without such an order, including South Dakota. Findings suggest complex relationships between tourism, SARS-CoV-2 infections, and mitigation strategies. The unique approach that South Dakota adopted provided insights into the spread of the disease in areas without state-wide restrictions. Our results suggest both positive and negative aspects of this approach. Finally, our data highlight the need for future surveillance efforts, including efforts focused on identifying variants with known increased transmission potential to produce effective population health management.

Adverse childhood experiences and prescription opioid use during pregnancy: an analysis of the North and South Dakota PRAMS, 2019-2020.

OBJECTIVES: This study assesses the association between adverse childhood experiences (ACEs) and prescription opioid use during pregnancy. METHODS: This study uses data on 2,999 individuals from the 2019 and 2020 Pregnancy Risk Assessment Monitoring System (PRAMS) from North Dakota and South Dakota. The relationship between ACEs and prescription opioid use during pregnancy is examined using multiple logistic regression. RESULTS: The prevalence of prescription opioid use increases alongside more ACE exposure. Compared to those with no ACEs, recent mothers with three or more ACEs have a 2.4 greater odds of prescription opioid use during pregnancy (aOR [adjusted odds ratio] = 2.437; 95% CI [confidence interval] = 1.319, 4.503). CONCLUSION: Exposure to three or more ACEs are associated with a higherrisk of prescription opioid use during pregnancy. Additional research is needed better understand the mechanisms that link ACEs and prescription opioid use during pregnancy, as well as how to best support those with ACEs exposure in a trauma-informed manner to reduce the risk of substance use.

State of South Dakota's Child: 2022.

In 2021, South Dakota observed an increase in the number of births from 2020 when the state experienced its lowest historic birth rate. Nonetheless, this increase represented a 3.7 percent decrease from the state's previous five year (2016-2020) mean of live births. This growth in the 2021 cohort of newborns was seen almost entirely among its white population. Further, South Dakota's current rate of birth remains slightly higher than that observed nationally. Over recent years, the racial diversity of South Dakota's newborns became similar to that observed nation-wide with nearly one quarter being American Indian, Black or Other races (AIBO). This trended down in 2021 with 22 percent of the state's newborns AIBO. Further, in South Dakota, the percent of all AIBO newborns who are American Indian is decreasing. Currently, 60 percent of the AIBO population is American Indian compared to more than 90 percent in 1980. During the pandemic years of 2020 and 2021, racial disparities in perinatal outcome occurring during previous years continued to be observed but the onset of prenatal care in the first trimester for both white or AIBO pregnant women did not change. There were 71 infant deaths in 2021 yielding a decrease in South Dakota's infant mortality rate (IMR) from 7.4 to 6.3 (higher than the 5.4 IMR for 2020 for the U.S.). Though there was a decrease in the state's 2021 IMR to 6.3, the reduced rate from its previous five year mean of 6.5 is not statistically significant. The state's 2021 neonatal mortality rate (NMR = 0 to 27 days per 1,000 live births) and post neonatal mortality rate (PNMR=28 to 364 days per 1,000 live births) dropped for the white population and increased for the AIBO population, though the actual number of AIBO deaths associated with these rate increases were low. Between 2017- 2021, the South Dakota rates of death for AIBO compared to white newborns was significantly higher for perinatal causes, sudden unexpected death (SUID), and other causes. Compared to the U.S.' 2020 rates of infant mortality, South Dakota's comparable 2017-21 rates were significantly higher for congenital anomalies. In 2021 there were 15 deaths in the state due to SUID; a decrease from the previous year, yet little overall improvement in decreasing the rate of this cause of death has not been achieved. Between 2017 and 2021, SUIDs comprised 22 percent of infant deaths for both white and AIBO infants. A discussion of strategies to prevent these persisting tragedies is presented.

A Single Site, Retrospective Chart Review of Renal Transplant Graft Failure and Mortality Rates Pre and Post COVID-19 Pandemic.

INTRODUCTION: Immunosuppressed patients are at an increased risk of complications from COVID-19. Despite the morbidity and mortality associated with COVID-19, there is little information regarding its effect on post-renal transplant patients. This study investigated the impact of a COVID-19 diagnosis on renal transplant recipients in terms of graft failure and mortality. METHODS: Renal transplant recipients were included if they had a functioning graft between March 2020 and March 2022. COVID-19 test results, duration from COVID-19 to graft failure and mortality, vaccination status, and COVID-19 treatment regimen were recorded and analyzed. RESULTS: There were 175 renal transplant recipients who met study criteria. Of these, 82 patients had documented COVID-19 cases, and 93 patients did not have a documented case. Of the patients who had a COVID-19 positive test, 3 experienced renal graft failure, and 15 experienced mortality. When comparing graft failure rate between the two groups, there was no significant difference. The mortality risk was significantly increased in COVID-19 positive patients (p=0.021). The COVID-19 immunization rate (at least one dose) was 82.5% for renal transplant recipients compared to 77.2% for all of South Dakota. CONCLUSIONS: There was no significant difference in renal graft failure rate between the two groups, but there was a significantly increased mortality risk in patients with COVID-19 positivity.

Myocarditis in Minnehaha County, South Dakota, 1880-1939.

From 1920 to 1940 in Minnehaha County there was an apparent striking increase in the incidence of fatal myocarditis and chronic myocarditis. Based on an analysis of the interment records of the Mt. Pleasant Cemetery, word frequency studies in two prominent American medical journals and a general review of related medical publications, we explore this increase. We conclude that there was no actual increase in the frequency of inflammatory disorders of the myocardium in Minnehaha County during this period. Rather, it appears that the use of the diagnostic terms was a matter of choice among local physicians that was not supported by contemporaneous clinical and pathophysiologic publications in available journals.