Carbon footprint of South Dakota dairy production system and assessment of mitigation options.

Livestock production contributes to greenhouse gas (GHG) emissions. However, there is a considerable variability in the carbon footprint associated with livestock production. Site specific estimates of GHG emissions are needed to accurately focus GHG emission reduction efforts. A holistic approach must be taken to assess the environmental impact of livestock production using appropriate geographical scale. The objective of this study was to determine baseline GHG emissions from dairy production in South Dakota using a life cycle assessment (LCA) approach. A cradle-to-farm gate LCA was used to estimate the GHG emissions to produce 1 kg of fat and protein corrected milk (FPCM) in South Dakota. The system boundary was divided into feed production, farm management, enteric methane, and manure management as these activities are the main contributors to the overall GHG emissions. The production of 1 kg FPCM in South Dakota dairies was estimated to emit 1.23 kg CO2 equivalents. The major contributors were enteric methane (46%) and manure management (32.7%). Feed production and farm management made up 14.1 and 7.2%, respectively. The estimate is similar to the national average but slightly higher than the California dairy system. The source of corn used in the dairies influences the footprint. For example, South Dakota corn had fewer GHG emissions than grain produced and transported in from Iowa. Therefore, locally and more sustainably sourced feed input will contribute to further reducing the environmental impacts. Improvements in efficiency of milk production through better genetics, nutrition animal welfare and feed production are expected to further reduce the carbon footprint of South Dakota dairies. Furthermore, anaerobic digesters will reduce emissions from manure sources.

Experience Implementing a Public Health Surveillance System Designed for Fathers of Infants on a South Dakota American Indian Reservation.

INTRODUCTION: Paternal behaviors and attitudes during pregnancy are not known. A health survey for fathers of recently born infants was developed to be administered concurrently with a maternal survey to assess parental behaviors and attitudes before, during and after pregnancy. METHODS: Participants were parents of 149 American Indian infants born from April 1 and Dec. 31, 2015 who were recruited prospectively from data of all births in prespecified reservation counties representing Sisseton Wahpeton Oyate of the Lake Traverse Reservation. Data collection was via hard-copy or online survey. RESULTS: Response rate among mothers was 62 percent (n=92). Of 149 births, 126 listed a father on the birth certificate and 51 percent (n=64) of these completed surveys on average 4.7 months post-birth. Healthwise, 90 percent of fathers reported being overweight or obese, but a small percent visited a health care worker in the previous year to be checked for diabetes (11 percent) or hypertension (14 percent). Among fathers who smoked in the last two years (73 percent), 77 percent of the mothers also smoked compared to 20 percent of mothers smoking if the father did not smoke. Nearly three-fourths of fathers were supportive of breastfeeding (70 percent), and mothers whose partners were supportive were more likely to breastfeed than those with unsupportive partners (91 percent vs. 50 percent, respectively. The majority of fathers attended prenatal visits (57 percent), the delivery (88 percent), and some or all well-baby checks (73 percent) with the main barrier stated as not being able to take time off work. CONCLUSION: Conducting a health survey with both fathers and mothers in a reservation setting is feasible and the father's attitudes and behaviors related to breastfeeding and smoking were associated with maternal health behaviors. Most fathers attended health care visits with the mother, but they were not being screened for health conditions despite a large proportion being overweight and smokers. Prenatal and antenatal visits may provide an opportune time to engage fathers and address paternal health issues.

Varied Health Spending Growth Across US States Was Associated With Incomes, Price Levels, And Medicaid Expansion, 2000-19.

Little is known about health care spending variation across the US for recent years. To estimate health spending by state and payer, we combined data from the government's State Health Expenditure Accounts, which have estimates through 2014, with other primary data on spending. In 2019 state-specific per person spending ranged from $7,250 to $14,500. After adjustment for inflation, annualized per person spending growth for each state ranged from 1.0 percent in Washington, D.C., to 4.2 percent in South Dakota between 2013 and 2019. The factors that explained the most variation across states were incomes (25.3 percent) and consumer prices (21.7 percent). Medicaid expansion was associated with increases in total spending per person, although the median of spending in expansion states showed slower growth in out-of-pocket spending than the median in nonexpansion states. Contemporary estimates of state health spending are valuable for tracking divergent expenditure trajectories in the US and assessing the associated factors.

Osteohistological and taphonomic life-history assessment of Edmontosaurus annectens (Ornithischia: Hadrosauridae) from the Late Cretaceous (Maastrichtian) Ruth Mason dinosaur quarry, South Dakota, United States, with implication for ontogenetic segregation between juvenile and adult hadrosaurids.

The Late Cretaceous (Maastrichtian) Ruth Mason Dinosaur Quarry (RMDQ) represents a monodominant Edmontosaurus annectens bonebed from the Hell Creek Formation of South Dakota and has been determined as a catastrophic death assemblage likely belonging to a single population, providing an ideal sample to investigate hadrosaurid growth and population dynamics. For this study, size-frequency distributions were constructed from linear measurements of long bones (humeri, femora, tibiae) from RMDQ that revealed five relatively distinct size classes along a generally right-skewed distribution, which is consistent with a catastrophic assemblage. To test the relationship between morphological size ranges and ontogenetic age classes, subsets from each size-frequency peak were transversely thin-sectioned at mid-diaphysis to conduct an ontogenetic age assessment based on growth marks and observations of the bone microstructure. When combining these independent datasets, growth marks aligned with size-frequency peaks, with the exclusion of the overlapping subadult-adult size range, indicating a strong size-age relationship in early ontogeny. A growth curve analysis of tibiae indicated that E. annectens exhibited a similar growth trajectory to the Campanian hadrosaurid Maiasaura, although attaining a much larger asymptotic body size by about 9 years of age, further suggesting that the clade as a whole may have inherited a similar growth strategy. This rich new dataset for E. annectens provides new perspectives on other hypotheses of hadrosaurid life history. When the RMDQ population was compared with size distributions from other hadrosaurid bonebed assemblages, juveniles (categorized as ages one and two) were either completely absent from or heavily underrepresented in the samples, providing support for the hypothesized segregation between juvenile and adult hadrosaurids. Osteohistological comparison with material from polar and temperate populations of Edmontosaurus revealed that previous conclusions correlating osteohistological growth patterns with the strength of environmental stressors were a result of sampling non-overlapping ontogenetic growth stages.

A Survey of Eye Care Needs Among Community Health Center Patients in Western South Dakota.

BACKGROUND: Community health centers (CHCs) provide healthcare to underserved communities, including the uninsured and underinsured. Ocular disease and visual impairment affect individuals of all ages, race, and socioeconomic standing, but are disproportionately detrimental to individuals with limited access to care. The purpose of this study is to assess the need for and potential utilization of an on-site eye care clinic at a CHC in Rapid City, South Dakota. METHODS: A 22-question survey was distributed to patients 18 years and older at Community Health Center of the Black Hills (CHCBH) to gather demographic, socioeconomic, medical, and subjective interest data. RESULTS: A total of 421 surveys were included in the analysis. Of these, 364 respondents (87 percent) indicated being "Very likely" or "Somewhat likely" to use an on-site eye clinic at CHCBH (95 percent CI 83-90 percent). A total of 217 respondents (52 percent) endorsed a diagnosis of an existing eye condition and/or diabetes, and 215 respondents (51 percent) rated their vision as "Poor" or "Very poor." Less than half of respondents indicated having any form of health insurance (191, 45 percent) but showed a comparably high likelihood of using an on-site eye clinic when compared to uninsured respondents, 90 percent and 84 percent, respectively. Finally, 50 (12 percent) respondents indicated being referred to an eye doctor in the past, with affordability as the most commonly cited reason for not following through with the referral. CONCLUSIONS: Survey data indicate a medical and socioeconomic need for eye care services among CHCBH patients and a high likelihood patients would seek care at an on-site clinic.

Travel Distance for Rural South Dakota Dermatology Care.

BACKGROUND: Nearly 40 percent of dermatologists in the U.S. practice in the 100 most population dense areas, with less than 10 percent practicing in rural areas. Rurality, delayed detection time, and increased travel distance have been associated with worse malignancy outcomes. Without their local rural dermatologist, we hypothesized patients would face significantly increased travel distance and be less likely to receive dermatological care. METHODS: A survey was created to assess travel distance, likelihood to travel further for care, and use of primary care providers for dermatologic care. Eligible participants of the IRB approved study were patients of the only dermatology clinic in Yankton, South Dakota. Yankton is a town in southeastern South Dakota with a population of 14,687. RESULTS: Overall, 100 surveys were completed. Most patients (53.5 percent) did not know where they would receive dermatologic care if the dermatology clinic was not available. The average patient would travel 42.6 miles further to the closest non-outreach dermatology clinics. Over 25 percent of patients were unlikely or not willing to travel further for care. As patient's age increased, so did their likelihood to travel further. CONCLUSIONS: The data supports the hypothesis that without their local rural dermatologist, patients would face significantly increased travel distance and be less likely to receive dermatological care. Given the barriers to care in rural areas, it is imperative to proactively confront these challenges. Further studies are needed to assess for confounding factors in this dynamic and develop innovative solutions.

A Survey of Eye Care Needs Among Community Health Patients in Western South Dakota.

INTRODUCTION: Community Health Centers (CHCs) provide healthcare to underserved communities, including the uninsured and underinsured. Ocular disease and visual impairment affect individuals of all ages, race, and socioeconomic standing, but are disproportionately detrimental to individuals with limited access to care. The purpose of this study is to assess the need for and potential utilization of an on-site eye care clinic at a CHC in Rapid City, South Dakota. METHODS: A 22-question survey was distributed to patients 18 years and older at Community Health Center of the Black Hills (CHCBH) to gather demographic, socioeconomic, medical, and subjective interest data. RESULTS: A total of 421 surveys were included in the analysis. Of these, 364 respondents (87%) indicated being "Very likely" or "Somewhat likely" to use an on-site eye clinic at CHCBH. A total of 217 respondents (52%) endorsed a diagnosis of an existing eye condition and/or diabetes, and 215 respondents (51%) rated their vision as "Poor" or "Very poor." Less than half of respondents indicated having health insurance such as private insurance, Medicaid, Medicare, State Children's Health Insurance Program (CHIP), Indian Health Services, Military insurance, or other public or government insurance programs (191, 45%) but showed a comparably high likelihood of using an on-site eye clinic when compared to their uninsured counterparts, 90% and 84%, respectively. Finally, 50 (12%) respondents indicated they had been referred to an eye doctor in the past, with affordability as the most cited reason for not following through with the referral. CONCLUSIONS: Survey data indicate a medical and socioeconomic need for eye care services among CHCBH patients and a high likelihood patients would seek care at an on-site clinic.

Perceptions of Palliative Care: Voices From Rural South Dakota.

OBJECTIVES: This study aimed to explore health professional, patient, family, and caregiver perceptions of palliative care, availability of palliative care services to patients across South Dakota, and consistency and quality of palliative care delivery. METHODS: Six focus groups were conducted over two months. Participants included interprofessional healthcare team members, patients, family members of patients, and caregivers. Individuals with palliative care experiences or interest in palliative care were invited to participate. Recruitment strategies included emails, flyers, and direct contact by members of the Network. Snowball sampling was used to recruit participants. RESULTS: Forty-six participants included patients, family members, caregivers and interprofessional health care team members. Most participants were Caucasian (93.3%) and female (80%). Six primary themes emerged: Need for guidance toward the development of a holistic statewide palliative care model; Poor conceptual understanding and awareness; Insufficient resources to implement complete care in all South Dakota communities; Disparities in the availability and provision of care services in rural SD communities; Need for relationship and connection with palliative care team; and Secondary effects of palliative care on patients/family/caregivers and interprofessional healthcare team members. Significance of Results: Disproportionate access is a principle problem identified for palliative care in rural South Dakota. Palliative care is poorly understood by providers and recipients of care. Service reach is also tempered by lack of resources and payer reimbursement constraints. A model for palliative care in these rural communities requires concerted attention to their unique needs and design of services suited for the rural residents.

E-cigarette Use Among Youth: Results from the 2019 South Dakota Youth Tobacco Survey.

BACKGROUND: The prevalence of e-cigarette use among youth is increasing in an alarming rate nationwide with over 5 million students currently using e-cigarettes in 2019. To better understand e-cigarette use in South Dakota, we examined the prevalence, access, reasons, and harm perception of e-cigarette among South Dakota youth. METHODS: We analyzed a representative sample of sixth to eighth grade students from the 2019 South Dakota Youth Tobacco Survey (YTS). Weighted estimates were computed to account for the complex sampling design and estimates were analyzed by geographic location and race/ethnicity. RESULTS: Among the 2,346 students, the prevalence of ever use of e-cigarettes among middle school students was 16.0 percent, a nearly 100 percent increase from 2017 YTS findings (8.2 percent). Approximately, seven percent (6.7 percent) reported use of an e-cigarette in the past 30 days, a nearly threefold increase from 2017 results (2.5 percent). Prevalence of current e-cigarette use was significantly higher among American Indian (12.7 percent) students and rural (8.3 percent) school students. The most common reported reasons for e-cigarette use was having friends/ family members that use them (49.6 percent) but also availability of flavors (18.6 percent). E-cigarette users obtained e-cigarettes predominantly through social sources (e.g., friends and peers). Nearly 30 percent (27.3 percent) reported not having enough information about e-cigarette's harm. CONCLUSIONS: In 2019, e-cigarettes were the most commonly used tobacco product among South Dakota middle school students. We found geographic and racial/ethnic disparity in e-cigarette use. Social influence and availability of flavors were important factors in promoting e-cigarette use. Continued efforts to implement population-level strategies to reduce e-cigarette use among youth are needed.

Basic Disaster Preparedness of Rural Community Pharmacies in 5 States.

OBJECTIVES: The aim of this study was to investigate the basic preparedness of rural community pharmacies to continue operations during and immediately following a disaster. METHODS: In 2014, we conducted a telephone survey (N = 990) of community pharmacies in 3 rural areas: North Dakota/South Dakota, West Virginia, Southern Oregon/Northern California regarding whether they had a formal disaster/continuity plan, offsite data backup, emergency power generation, and/or had a certified pharmacy immunizer on staff. Logistic regression and chi square were performed using Stata 11.1. FINDINGS: Community pharmacies in rural areas (≤50.0 persons/mile2) were less likely to have emergency power (odds ratio [OR] = 0.59; 95% confidence interval [CI]: 0.32-1.07) or certified pharmacy immunizer on staff (OR = 0.47; 95% CI: 0.34-0.64). Pharmacies in lower income areas were less likely to have emergency power and offsite data backup or a formal disaster plan (OR = 0.70; 95% CI: 0.49-0.99) compared with pharmacies in higher income areas. Community pharmacies in areas of higher percent elderly population were less likely to have emergency power (OR = 0.54; 95% CI: 0.39-0.73), or certified pharmacy immunizer on staff (OR = 0.65; 95% CI: 0.47-0.91) compared with chain pharmacies in areas with lower percent elderly population. CONCLUSIONS: Being in a rural, low-income, or high-elderly area was associated with lower likelihood of basic preparedness of community pharmacies.

Not a One-Size-Fits-All Approach: Building Tribal Infrastructure for Research Through CRCAIH.

The Collaborative Research Center for American Indian Health (CRCAIH) was created to foster tribal partnerships in the Minnesota, North Dakota, and South Dakota regions to increase capacity for tribal research. Since 2013, through community engagement and technical assistance from CRCAIH's cores and divisions, seven tribal partners have expanded research infrastructure and recognize the benefits of an established tribal research office. This manuscript showcases the unique approaches individual CRCAIH tribal partners have taken to build tribal research infrastructure. The unique experiences of the CRCAIH tribal partnership holds valuable lessons for other tribes interested in increasing research capacity through research review, regulation, and data management.

Developing the Tribal Resource Guide and the Poverty and Culture Training: The We RISE (Raising Income, Supporting Education) Study.

The We RISE Study aimed to support young American Indian mothers on a tribal reservation by addressing social determinants of health at an individual and community-wide level. To address community-based barriers, the study developed the Tribal Resource Guide, a comprehensive list of available resources that was created through partnerships with community programs and staff. In addition to the guide, the study also developed the Poverty and Culture Training in order to train program staff at numerous community programs to better understand and serve lower socioeconomic and/or Native clients. The two projects facilitated collaboration between community programs and provided tools for programs to address barriers and ultimately better serve their target audience. Despite challenges, the transdisciplinary approach used with the local community maximized potential for success. This process and model could be duplicated in communities with similar demographics, resources, and barriers.

A Review of Childhood Vision Screening Laws and Programs Across the United States.

INTRODUCTION: Many organizations recommend childhood vision screenings. Furthermore, 42 out of 50 states in the U.S. have laws requiring these examinations looking for multiple ocular abnormalities that can lead to amblyopia, which has the potential to result in lifelong visual impairment. Currently, South Dakota is not a state with similar aforementioned law. The purpose of this research was to examine vision screening laws and programs across America to potentially provide a framework from which South Dakota could adopt its own law. METHODS: This is a healthcare policy review of childhood vision screenings across the U.S. government websites and departments of education and/or health were contacted for information regarding laws and their processes of vision screenings. The University of South Dakota Sanford School of Medicine (USD SSOM) Pediatric Residency Program was queried on their current practice. The 14 largest school districts in South Dakota were questioned on their policies. Other current regular childhood health screenings in South Dakota were also investigated. RESULTS: Most states utilize the public school systems and school personnel in performing screenings. The USD SSOM Pediatric Residency Program routinely screens children at kindergarten physical exams. The majority of the largest school districts in South Dakota routinely screen their students using a variety of methods. There are a few other routine health screenings covered by insurance and Medicaid in South Dakota. CONCLUSION: South Dakota does not have a law requiring childhood vision screenings. Despite this, many screenings are still performed in schools or in medical offices.

A County-Level Health Index to Capture Geographic Variation in Health Conditions in North Dakota, South Dakota, and Minnesota.

INTRODUCTION: Individual health is influenced by multiple, potentially correlated factors including healthcare availability, community context, and socioeconomic factors. To measure the health changes at county-levels across North Dakota, South Dakota, and Minnesota, a measure of relative health, health index, was developed incorporating multiple indicators from domains of health conditions, health behaviors, and social determinants. METHODS: We combined data from all 206 counties in the aforementioned three states for the years 2008-2012 from multiple data sources. We performed factor analysis that accounted for a hierarchical structure of the overall health index comprising of 15 indicators. RESULTS: A hierarchical structure is identified in which three intermediate factors are connecting the health index with 15 health indicators. The grouping results of the 206 counties based on health index values demonstrate the existence of a gradient in health conditions in the Northern Plains. CONCLUSIONS: The health status of urban areas was generally better than that of rural areas in the Northern Plains during this study period. The developed index adds stability to the estimates of the population characteristics, especially in rural, sparsely populated counties.

Survivorship Care Plans: Health Actions Taken and Satisfaction After Use.

OBJECTIVES: To examine the use of and assess patient satisfaction with survivorship care plans (SCPs). SAMPLE & SETTING: 189 cancer survivors recruited from five cancer treatment center locations (Avera Cancer Institute in Aberdeen, Mitchell, Sioux Falls, and Yankton; Sanford Cancer Center in Sioux Falls) and one auxiliary specialty center (Urology Specialists in Sioux Falls), all in South Dakota. METHODS & VARIABLES: A written survey was completed by participants before and three months after receiving an SCP. Associations between demographics and cancer-related characteristics and use of the SCP were evaluated using chi-square tests. Logistic regression was used to determine factors associated with any use of the SCP, health actions attributable to the SCP, and satisfaction with the SCP. RESULTS: The most frequently reported uses of the SCP were to share with spouse or partner, inform about symptoms, and ask physician or nurse about concerns. SCP use, health actions taken, and satisfaction with the SCP were associated with gender, marital status, and main cancer type. IMPLICATIONS FOR NURSING: Nurses should promote SCPs because they are valued and used by survivors for follow-up care.

Physicians and Reform: The State of The Art and The Challenge to Physicians.

Within the context of medical reformation outlined by Hoffman in a series of three papers in South Dakota Medicine and the challenge of legislation involving the independent practice of advanced practice nurses, we undertook two surveys of physicians and patients. We wanted to better understand physicians' attitudes toward certain opportunities for reform and how they conformed to the viewpoints of our patients. We found that, at least with respect to nurse practice legislation, physicians' perceptions were at odds with their patients over questions of access and quality. Moreover, we found attitudinal differences among physicians depending upon whether they were independent or affiliated with a health care system and whether they were primary care physicians or specialists. We concluded that physicians do not yet share the common understanding necessary to advocate for a principle of medical practice encompassing the core needs of patients and the spectrum of caregivers.

Effects of a Behavioral Health and Chronic Illness Care Intervention on Patient Outcomes in Primary Care Practices in the Dakotas.

From 2012 to 2015, Sanford Health, a large health care system, integrated behavioral health services and chronic condition care management in some of its primary care practices in the Dakotas and rural Minnesota. Using difference-in-differences analyses for fee-for-service Medicare beneficiaries attributed to 22 participating practices and 91 matched comparison practices, we found that the program increased the receipt of four recommended diabetes care processes by 8.6% (p=.048) and, by slowing the increase in emergency department (ED) visits, reduced them by 4.9% (p=.07) relative to the comparison group. However, the findings are mixed: the program did not affect hospital admissions, readmissions, or Medicare spending. In addition, the program increased admissions for ambulatory care-sensitive conditions by 13.6% (p=.07) relative to the comparison group. Sanford's program provides a concrete example of how to incorporate behavioral health services in primary care in underserved areas with some positive results on quality-of-care processes and ED utilization.

A randomized trial to reduce smoking among American Indians in South Dakota: The walking forward study.

BACKGROUND: Lung cancer is an important public health issue, particularly among American Indians (AIs). The reported decline in tobacco use for most racial/ethnic groups is not observed among AIs. This project was designed to address the research question, "Why don't more Northern Plains American Indians alter tobacco use behaviors known to increase the risk of cancer?" METHODS: Guided by the Theory of Planned Behavior, a multi-component intervention study was implemented. Adult AIs, age 18 years or older and currently smoking, were enrolled. Eligible subjects were randomized to one of 15 groups and exposed to either a MINIMAL or an INTENSE level of 4 intervention components. The intervention was delivered face-to-face or via telephone by Patient Navigators (PN). The primary outcome was self-reported abstinence from smoking verified by carbon monoxide measurement. RESULTS: At 18 months post-quit date, 88% of those who were still in the study were abstinent. This included 6% of all participants who enrolled in the study (14/254) and 13% of those who made it to the quit date (14/108). No intervention groups were found to have significant proportions of participants who were abstinent from smoking at the quit date (visit 5) or primary outcome visit (18 months post-quit date, visit 11), but use of pharmacologic support for abstinence was found to be an effective strategy for individuals who continued participation throughout the study. Those who remained in the study received more visits and were more likely to be abstinent. CONCLUSIONS: Use of NRT increased the odds of not smoking, as assessed at the 18-month follow-up visit, but no other interventions were found to significantly contribute to abstinence from smoking. Although the intervention protocol included numerous points of contact between CRRs and participants (11 visits) loss to follow-up was extensive with only 16/254 remaining enrolled. Additional research is needed to improve understanding of factors that influence enrollment and retention in smoking cessation interventions for AI and other populations.