Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 195
Filtrar
1.
Am Surg ; 85(11): 1281-1287, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31775972

RESUMO

ACS-verified trauma centers show higher survival and improved mortality rates in states with ACS-verified Level I pediatric trauma centers. However, few significant changes are appreciated in the first two years after verification. Minimal research exists examining verification of ACS Level II pediatric trauma centers. We analyzed ACS Level II pediatric trauma verification at our institution. In 2014, Sanford Medical Center Fargo became the only Level II pediatric trauma center in North Dakota, as well as the only center between Spokane and Minneapolis. A retrospective review of the institution's pre-existing trauma database one year pre- and postverification was performed. Patients aged <18 years were included in the study (P < 0.05). Patient number increased by 23 per cent, from 167 to 205 patients. A statistically significant increase occured in the three to six year old age group (P = 0.0002); motorized recreational vehicle (P = 0.028), violent (P = 0.009), and other (P = 0.0374) mechanism of injury categories; ambulance (P = 0.0124), fixed wing (P = 0.0028), and personal-owned vehicle (P = 0.0112) modes of transportation. Decreased public injuries (P = 0.0071) and advanced life support ambulance transportation (P = 0.0397). The study showed a nonstatistically significant increase in mean Injury Severity Score (from 6.3 to 7) and Native American trauma (from 14 to 20 per cent). Whereas prolonged ACS Level I pediatric trauma center verification was found to benefit patients, minimal data exist on ACS Level II verification. Our findings are consistent with current Level I ACS pediatric trauma center data. Future benefits will require continued analysis because our Level II pediatric trauma center continues to mature and affect our rural and large Native American community.


Assuntos
Escala de Gravidade do Ferimento , Centros de Cuidados de Saúde Secundários/normas , Centros de Traumatologia/normas , Ferimentos e Lesões/epidemiologia , Adolescente , Distribuição por Idade , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Lactente , Recém-Nascido , Masculino , North Dakota/epidemiologia , Estudos Retrospectivos , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos , Distribuição por Sexo , Fatores de Tempo , Centros de Traumatologia/estatística & dados numéricos , Ferimentos e Lesões/etiologia
2.
Artigo em Inglês | MEDLINE | ID: mdl-31658605

RESUMO

Objective: The increasing rate of thyroid cancer diagnoses in the U.S. reflects the increasing use of ultrasonography and of specialist medical care. North Dakota is a rural state with limited access to specialist care, yet its incidence of thyroid cancer is significantly greater than that of the U.S. overall. We sought to identify factors responsible for the high incidence of thyroid cancer in North Dakota. Methods: We examined county-specific incidence rates for thyroid cancer in North Dakota in relation to demographic and geographic factors, including median household income, percent of land fertilized, cattle density per capita, and source of drinking water (city or well water), using structural equation modeling. We included county level data on residential radon levels and estimates of radioactive iodine in milk following nuclear weapons testing in the 1950s. Results: Thyroid cancer incidence rates were significantly associated with median income (p < 0.05); percent of land fertilized (p < 0.05); the use of city water (p < 0.01), and cattle density per capita (p < 0.001). Conclusions: The risk of thyroid cancer in North Dakota is positively associated with income and with factors related to land and water use. Our finding that thyroid cancer incidence rates are associated with the use of city water was unexpected and merits examination in other locations with a mix of city and well water use.


Assuntos
Radioisótopos do Iodo/toxicidade , Neoplasias da Glândula Tireoide/epidemiologia , Água , Animais , Bovinos , Feminino , Geografia , Humanos , Incidência , North Dakota/epidemiologia , Radônio/análise , População Rural , Neoplasias da Glândula Tireoide/etiologia
3.
Int J Colorectal Dis ; 34(9): 1571-1576, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31312891

RESUMO

PURPOSE: The state of North Dakota has one of the highest incidence rates for colorectal cancer in the USA. Its high incidence rate, coupled with a large variation in incidence rates among counties within the state, makes North Dakota a "natural laboratory" in which to investigate environmental clues to colorectal cancer. We conducted a hypothesis-generating study to explore potential determinants of colorectal cancer in North Dakota. METHODS: We obtained county-specific incidence rates for North Dakota's 53 counties from the statewide cancer registry and corresponding data on county demographic, agricultural, and geophysical features from population-based sources. Candidate demographic/agricultural variables included median household income, population density, colorectal cancer screening rates, average farm size (in acres), and the percent of county fertilized. Geophysical variables included the uranium content of soil, residential radon levels, and source of drinking water (municipal or well water). Statistical analyses were performed via multivariate regression and structural equation modeling. RESULTS: Colorectal cancer incidence rates across North Dakota counties varied 3-fold. The structural equation model identified a significant role for well water use (p < 0.05). This finding is consistent with studies that implicate well water in colorectal cancer. CONCLUSIONS: Well water contains several agents, e.g., bacteria, disinfection by-products, and nitrates that are potent colorectal carcinogens. Studies of well water use and colorectal cancer risk at the individual level in North Dakota are warranted.


Assuntos
Neoplasias Colorretais/epidemiologia , Análise de Classes Latentes , Geografia , Humanos , Incidência , Modelos Lineares , North Dakota/epidemiologia , Fatores de Risco
4.
Artigo em Inglês | MEDLINE | ID: mdl-30189592

RESUMO

The city of Bismarck, North Dakota has one of the highest numbers of West Nile Virus (WNV) cases per population in the U.S. Although the city conducts extensive mosquito surveillance, the mosquito abundance alone may not fully explain the occurrence of WNV. Here, we developed models to predict mosquito abundance and the number of WNV cases, independently, by statistically analyzing the most important climate and virus transmission factors. An analysis with the mosquito model indicated that the mosquito numbers increase during a warm and humid summer or after a severely cold winter. In addition, river flooding decreased the mosquito numbers. The number of WNV cases was best predicted by including the virus transmission rate, the mosquito numbers, and the mosquito feeding pattern. This virus transmission rate is a function of temperature and increases significantly above 20 °C. The correlation coefficients (r) were 0.910 with the mosquito-population model and 0.620 with the disease case model. Our findings confirmed the conclusions of other work on the importance of climatic variables in controlling the mosquito numbers and contributed new insights into disease dynamics, especially in relation to extreme flooding. It also suggested a new prevention strategy of initiating insecticides not only based on mosquito numbers but also 10-day forecasts of unusually hot weather.


Assuntos
Clima , Febre do Nilo Ocidental/epidemiologia , Animais , Humanos , Incidência , Inseticidas , Mosquitos Vetores/crescimento & desenvolvimento , North Dakota/epidemiologia , Estações do Ano , Temperatura , Febre do Nilo Ocidental/transmissão
5.
Matern Child Health J ; 22(10): 1519-1525, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29936660

RESUMO

Objectives High infant mortality rates among American Indians in North Dakota contribute to a 20-year gap in average age at death compared to whites. Geographic- and race-specific health disparities data to drive policy making and interventions are not well disseminated. The current study examines prenatal risk factors and birth outcomes between American Indian and whites in North Dakota. Methods A retrospective descriptive analysis of North Dakota live births from 2007 to 2012 was conducted. Period prevalence and prevalence ratios were calculated. Results The infant mortality rate from 2010 to 2012 for infants born to American Indian women was 3.5 times higher than whites. Racial disparities existed in education, teen births, tobacco use during pregnancy, and breastfeeding initiation. Disparities widened for inadequate prenatal care, illegal drug use during pregnancy, and infant mortality from 2007-2009 to 2010-2012 and narrowed for sexually transmitted infections and alcohol use during pregnancy. Conclusions for Practice American Indians are disproportionately affected by poor pregnancy and birth outcomes in North Dakota. Future geographic-specific American Indian research is warranted to aid current and future public health interventions.


Assuntos
Grupo com Ancestrais do Continente Europeu , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Índios Norte-Americanos/estatística & dados numéricos , Mortalidade Infantil , Resultado da Gravidez/epidemiologia , Adulto , Feminino , Humanos , Lactente , Recém-Nascido , North Dakota/epidemiologia , Gravidez , Resultado da Gravidez/etnologia , Cuidado Pré-Natal , Estudos Retrospectivos , Fatores de Risco
7.
Am J Ind Med ; 61(7): 556-565, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29635849

RESUMO

BACKGROUND: This study examined whether environmental variables including weather, road surface, time-of-day, and light conditions were associated with the severity of injuries resulting from bicycle-motor vehicle crashes. METHODS: Using log-binomial regressions, we analyzed 113 470 police reports collected between 2000 and 2014 in four U.S. states with environmental and injury severity information. "Severe" injuries included fatal and incapacitating injuries, and "non-severe" included non-incapacitating, possible or no-injuries. RESULTS: Light condition was significantly associated with the injury severity to the bicyclist with more severe injuries at dawn (RR = 1.62 [95%CI 1.35-1.94]) and during darkness (both lighted and unlighted roads: 1.32 [1.24-1.40], respectively, 1.57 [1.41-1.76]) as compared to daylight. In these conditions of low visibility, risk was further increased during early morning hours before 7 am (1.61 [1.22-2.13]). CONCLUSIONS: Crashes in low light conditions and during early morning hours are more likely to result in higher injury severity.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Ciclismo/lesões , Meio Ambiente , Luz , Iluminação , Veículos Automotores , Tempo (Meteorologia) , Ferimentos e Lesões/epidemiologia , Dirigir sob a Influência/estatística & dados numéricos , Humanos , Illinois/epidemiologia , Missouri/epidemiologia , New York/epidemiologia , North Dakota/epidemiologia , Análise de Regressão , Fatores de Tempo , Índices de Gravidade do Trauma
10.
J Pediatric Infect Dis Soc ; 6(3): 281-284, 2017 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-27656134

RESUMO

Reports of children with non-type b Haemophilus influenzae infection in the United States in recent years have been limited. Here, we report the spectrum and severity of disease associated with invasive non-type b H influenzae infection in 17 patients at 2 tertiary-care children's hospitals over a 2-year period. Meningitis was the most common diagnosis. The majority of the patients had neurologic sequelae, and 1 patient died. The high proportions of hospitalization, intensive care utilization, and neurologic complications reveal that non-type b H influenzae infection was associated with significant morbidity in this pediatric population.


Assuntos
Infecções por Haemophilus/epidemiologia , Haemophilus influenzae , Criança , Pré-Escolar , Feminino , Infecções por Haemophilus/microbiologia , Humanos , Lactente , Recém-Nascido , Masculino , North Dakota/epidemiologia , Índice de Gravidade de Doença , South Dakota/epidemiologia
11.
Am J Infect Control ; 45(2): 126-132, 2017 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-27816216

RESUMO

BACKGROUND: From March-May 2013, 3 cases of acute hepatitis C virus (HCV) infection were diagnosed among elderly patients residing at the same skilled nursing facility (facility A) and who received health care at hospital X during their likely exposure period. METHODS: We performed HCV testing of at-risk populations; quasispecies analysis was performed to determine relatedness of HCV in persons with current infection. Infection control practice assessments were conducted at facility A and hospital X. Persons residing in facility A on September 9, 2013, were enrolled in a case-control study to identify risk factors for HCV infection. RESULTS: Forty-five outbreak-associated infections were identified. Thirty cases and 62 controls were enrolled in the case-control study. Only podiatry (odds ratio, 11.6; 95% confidence interval, 2.4-57.2) and international normalized ratio monitoring by phlebotomy (odds ratio, 6.7; 95% confidence interval, 1.7-26.6) at facility A were significantly associated with case status. Infection control lapses during podiatry and point-of-care testing procedures at facility A were identified. CONCLUSIONS: HCV transmission was confirmed among residents of facility A. The exact mode of transmission was not able to be identified, but infection control lapses were likely responsible. This outbreak highlights the importance of prompt reporting and investigation of incident HCV infection and the need for adherence to basic infection control procedures by health care personnel.


Assuntos
Surtos de Doenças , Transmissão de Doença Infecciosa , Hepatite C/epidemiologia , Instituições de Cuidados Especializados de Enfermagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Feminino , Hepatite C/transmissão , Humanos , Controle de Infecções/métodos , Masculino , Pessoa de Meia-Idade , North Dakota/epidemiologia
12.
Hypertens Pregnancy ; 36(2): 131-137, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28001098

RESUMO

BACKGROUND AND OBJECTIVES: Pre-eclampsia (PE) shares a number of proposed pathophysiologic mechanisms related to those implicated in cardiovascular disease (CVD), such as endothelial dysfunction, inflammation, insulin resistance, and impaired renal regulation. PE has also been associated with subsequent hypertension, CVD, and related mortality in later life. METHODS: At follow-up, the four most recent blood pressures, body mass index (BMI), and use of hypertensive medications were recorded from clinic visits of 130 PE cases and 289 normal pregnancies. Student's t test, Chi-square testing, multivariate linear, and logistic regression were used in analysis. RESULTS: Follow-up measurements occurred a mean of 13.11 years post PE pregnancy. Multivariate linear regression showed a significant and independent association between current systolic blood pressure and previous history of PE (ß = 4.47, p = 0.04), while adjusting for age, BMI, and blood pressure from 1 year prior to and up to the 20th week of gestation. A similarly adjusted multivariate logistic regression model found an odds ratio of 3.43, 95% CI 1.83-6.43, p = 0.001 for subsequent hypertension. Logistic regression analysis of the quartile with follow-up of less than 7.19 years also shows independent association of prior PE with subsequent hypertension. DISCUSSION AND CONCLUSIONS: PE appears to confer risk of subsequent hypertension on this cohort of American Indian women within as little as 8 years. This risk is independent of additional risk factors such as increased age, BMI, and blood pressure prior to 20 weeks of gestation. There is evidence of increased risk among those with more severe PE.


Assuntos
Hipertensão/epidemiologia , Índios Norte-Americanos/estatística & dados numéricos , Pré-Eclâmpsia/epidemiologia , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , North Dakota/epidemiologia , Gravidez , Estudos Retrospectivos , Adulto Jovem
13.
Pediatr Infect Dis J ; 35(7): 728-32, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27078122

RESUMO

BACKGROUND: Since its introduction, palivizumab has been used to prevent respiratory syncytial virus (RSV) infection in high-risk populations. Recommendations for palivizumab administration changed in 2014. We examined whether adherence to 2014 palivizumab guidelines affected RSV hospitalization rates. METHODS: This was a retrospective sequential period analysis comparing the incidence of RSV hospitalization in patients younger than 2 years of age before and after implementation of 2014 palivizumab use criteria. Hospitalization data were prospectively collected through age-based surveillance for the post-2014 guideline period (November 1, 2014 to April 1, 2015 RSV season). Comparative data were collected retrospectively for hospitalizations during the pre-2014 guideline period of 2 previous RSV seasons (November 1, 2012 to April 1, 2013 and November 1, 2013 to April 1, 2014). The primary outcome was RSV hospitalization rate, and number of palivizumab doses administered was analyzed as a secondary outcome. RESULTS: During the study period, 194 RSV hospitalizations occurred. The rate of RSV hospitalization was 5.37 per 1000 children <24 months in the pre-2014 guideline period versus 5.78 per 1000 children <24 months in the post-2014 guideline period (difference of +0.4, 95% confidence interval: -1.2 to +2, P = 0.622). During the pre-2014 guideline period, 21.7 doses per 1000 children <24 months of palivizumab were administered, which decreased to 10.3 doses per 1000 children <24 months in the post-2014 guideline period, yielding a reduction of 11.4 doses per 1000 children <24 months (95% confidence interval: 14.3-8.4, P < 0.001). CONCLUSIONS: The implementation of 2014 palivizumab use criteria was not associated with an increased incidence of RSV hospitalization for children younger than 2 years of age but was associated with significantly less use of palivizumab.


Assuntos
Palivizumab/administração & dosagem , Infecções por Vírus Respiratório Sincicial/tratamento farmacológico , Infecções por Vírus Respiratório Sincicial/prevenção & controle , Antivirais/administração & dosagem , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Lactente , Recém-Nascido , North Dakota/epidemiologia , Vigilância da População , Guias de Prática Clínica como Assunto , Infecções por Vírus Respiratório Sincicial/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
14.
J Pediatr Health Care ; 30(4): 317-22, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26471515

RESUMO

INTRODUCTION: Insufficient sleep has been associated with engagement in a number of health-risk behaviors in adolescents, including substance use and sexual activity. Associations between sleep and health-risk behaviors in adolescents living in rural areas of the United States are not well investigated. In rural settings, adolescents' sleep patterns, lifestyle factors, and health-risk opportunities may differ from those of urban adolescents, making the independent study of sleep and health behavior associations necessary. METHOD: This study examined data from the Rural Adolescent Health Survey (N = 322) administered in rural North Dakota. RESULTS: Rural adolescents who reported engaging in smoking, alcohol use, or drug use slept significantly less than adolescents who did not report engaging in these activities. DISCUSSION: Sleep was not associated with chewing tobacco use or risky sexual activity, which may reflect an effect of rural cultural values on sleep and health-risk behavior associations.


Assuntos
Comportamento do Adolescente/psicologia , Consumo de Bebidas Alcoólicas/epidemiologia , Comportamentos de Risco à Saúde , Privação do Sono/psicologia , Sono/fisiologia , Fumar/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Consumo de Bebidas Alcoólicas/psicologia , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , North Dakota/epidemiologia , Assunção de Riscos , População Rural , Privação do Sono/epidemiologia , Privação do Sono/fisiopatologia , Fumar/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia
15.
J Health Care Poor Underserved ; 26(3): 1048-66, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26320932

RESUMO

INTRODUCTION: We investigated incidence and staging patterns of prostate, female breast, lung, and colorectal cancer among American Indians/Alaska Natives (AI/ANs) and non-Hispanic Whites (NHWs) in the Northern Plains. METHODS: Cancer registry data (2002-2009) from Nebraska, North Dakota, and South Dakota were analyzed. Incidence rates were calculated and multivariate logistic regression analyses identified factors associated with unstaged versus staged and late-stage cancer cases versus early. RESULTS: The incidence rate was higher among AI/ANs than NHWs for lung cancer (92.2 vs. 60.6 per 100,000). Compared with NHWs, AI/ANs were 2.0 times more likely to receive an unstaged diagnosis and 1.2 times more likely to receive a late-stage diagnosis. AI/ANs were significantly more likely than NHWs to receive an unstaged diagnosis. DISCUSSION: Increased efforts are needed to reduce unstaged and late-stage diagnoses among Northern Plains AIs. Efforts to promote early detection of cancer should target younger AI/ANs.


Assuntos
Nativos do Alasca/estatística & dados numéricos , Neoplasias da Mama/etnologia , Neoplasias Colorretais/etnologia , Disparidades nos Níveis de Saúde , Índios Norte-Americanos/estatística & dados numéricos , Neoplasias Pulmonares/etnologia , Neoplasias da Próstata/etnologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/patologia , Neoplasias Colorretais/patologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Incidência , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Nebraska/epidemiologia , Estadiamento de Neoplasias , North Dakota/epidemiologia , Neoplasias da Próstata/patologia , Sistema de Registros , South Dakota/epidemiologia
16.
J Nutr ; 145(10): 2265-72, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26338891

RESUMO

BACKGROUND: Public health recommendations call for a reduction in added sugars; however, controversy exists over whether all nutritive sweeteners produce similar metabolic effects. OBJECTIVE: The objective was to compare the effects of the chronic consumption of 3 nutritive sweeteners [honey, sucrose, and high-fructose corn syrup containing 55% fructose (HFCS55)] on circulating glucose, insulin, lipids, and inflammatory markers; body weight; and blood pressure in individuals with normal glucose tolerance (GT) and those with impaired glucose tolerance (IGT). METHODS: In a crossover design, participants consumed daily, in random order, 50 g carbohydrate from assigned sweeteners for 2 wk with a 2- to 4-wk washout period between treatments. Participants included 28 GT and 27 IGT volunteers with a mean age of 38.9 ± 3.6 y and 52.1 ± 2.7 y, respectively, and a body mass index (in kg/m(2)) of 26 ± 0.8 and 31.5 ± 1.0, respectively. Body weight, blood pressure (BP), serum inflammatory markers, lipids, fasting glucose and insulin, and oral-glucose-tolerance tests (OGTTs) were completed pre- and post-treatment. The OGTT incremental areas under the curve (iAUCs) for glucose and insulin were determined and homeostasis model assessment of insulin resistance (HOMA-IR) scores were calculated. RESULTS: Body weight and serum glucose, insulin, inflammatory markers, and total and LDL-cholesterol concentrations were significantly higher in the IGT group than in the GT group at baseline. Glucose, insulin, HOMA-IR, and the OGTT iAUC for glucose or insulin did not differ by treatment, but all responses were significantly higher in the IGT group compared with the GT group. Body weight was unchanged by treatment. Systolic BP was unchanged, whereas diastolic BP was significantly lower in response to sugar intake across all treatments. An increase in high-sensitivity C-reactive protein (hsCRP) was observed in the IGT group in response to all sugars. No treatment effect was observed for interleukin 6. HDL cholesterol did not differ as a result of status or treatment. Triglyceride (TG) concentrations increased significantly from pre- to post-treatment in response to all sugars tested. CONCLUSIONS: Daily intake of 50 g carbohydrate from honey, sucrose, or HFCS55 for 14 d resulted in similar effects on measures of glycemia, lipid metabolism, and inflammation. All 3 increased TG concentrations in both GT and IGT individuals and elevated glycemic and inflammatory responses in the latter. This trial was registered at clinicaltrials.gov as NCT01371266.


Assuntos
Proteína C-Reativa/agonistas , Sacarose na Dieta/efeitos adversos , Intolerância à Glucose/metabolismo , Xarope de Milho Rico em Frutose/efeitos adversos , Mel/efeitos adversos , Resistência à Insulina , Adoçantes Calóricos/efeitos adversos , Adulto , Biomarcadores/sangue , Índice de Massa Corporal , Proteína C-Reativa/análise , Estudos Cross-Over , Feminino , Intolerância à Glucose/complicações , Intolerância à Glucose/epidemiologia , Intolerância à Glucose/imunologia , Humanos , Hipertrigliceridemia/etiologia , Hipertrigliceridemia/prevenção & controle , Masculino , Pessoa de Meia-Idade , North Dakota/epidemiologia , Adoçantes Calóricos/uso terapêutico , Obesidade/complicações , Sobrepeso/complicações , Pacientes Desistentes do Tratamento , Fatores de Risco , Triglicerídeos/agonistas , Triglicerídeos/sangue
17.
Epidemiology ; 26(4): 601-12, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25929811

RESUMO

BACKGROUND: Few studies have evaluated associations between low to moderate arsenic levels and chronic kidney disease (CKD). The objective was to evaluate the associations of inorganic arsenic exposure with prevalent and incident CKD in American Indian adults. METHODS: We evaluated the associations of inorganic arsenic exposure with CKD in American Indians who participated in the Strong Heart Study in 3,851 adults ages 45-74 years in a cross-sectional analysis, and 3,119 adults with follow-up data in a prospective analysis. Inorganic arsenic, monomethylarsonate, and dimethylarsinate were measured in urine at baseline. CKD was defined as estimated glomerular filtration rate ≤ 60 ml/min/1.73 m, kidney transplant or dialysis. RESULTS: CKD prevalence was 10.3%. The median (IQR) concentration of inorganic plus methylated arsenic species (total arsenic) in urine was 9.7 (5.8, 15.7) µg/L. The adjusted odds ratio (OR; 95% confidence interval) of prevalent CKD for an interquartile range in total arsenic was 0.7 (0.6, 0.8), mostly due to an inverse association with inorganic arsenic (OR: 0.4 [0.3, 0.4]). Monomethylarsonate and dimethylarsinate were positively associated with prevalent CKD after adjustment for inorganic arsenic (OR: 3.8 and 1.8). The adjusted hazard ratio of incident CKD for an IQR in sum of inorganic and methylated arsenic was 1.2 (1.03, 1.41). The corresponding HRs for inorganic arsenic, monomethylarsonate, and dimethylarsinate were 1.0 (0.9, 1.2), 1.2 (1.00, 1.3), and 1.2 (1.0, 1.4). CONCLUSIONS: The inverse association of urine inorganic arsenic with prevalent CKD suggests that kidney disease affects excretion of inorganic arsenic. Arsenic species were positively associated with incident CKD. Studies with repeated measures are needed to further characterize the relation between arsenic and kidney disease development.


Assuntos
Arsênico/urina , Exposição Ambiental/estatística & dados numéricos , Índios Norte-Americanos/estatística & dados numéricos , Insuficiência Renal Crônica/epidemiologia , Idoso , Arizona/epidemiologia , Arsenicais/urina , Ácido Cacodílico/urina , Estudos de Coortes , Estudos Transversais , Feminino , Taxa de Filtração Glomerular , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , North Dakota/epidemiologia , Oklahoma/epidemiologia , Prevalência , Modelos de Riscos Proporcionais , Estudos Prospectivos , South Dakota/epidemiologia , Estados Unidos/epidemiologia
18.
J Wildl Dis ; 51(3): 670-9, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25973622

RESUMO

The meningeal worm (Parelaphostrongylus tenuis) is a parasite of white-tailed deer (Odocoileus virginianus) and is also a significant pathogen of moose (Alces alces) and other ungulates. Changes in climate or habitat may facilitate range expansion or increase the prevalence of meningeal worm infection in white-tailed deer, resulting in increased exposure to susceptible ungulates. We examined 3,730 white-tailed deer during 2002-05 to determine the prevalence and range of meningeal worm infection in North Dakota, US, and investigated whether these had changed since earlier surveys. We used multiple logistic regression to model potential effects of habitat and climate on prevalence in white-tailed deer. We also examined how habitat influences intermediate hosts by comparing gastropod abundance and microclimate among habitat types. Prevalence in deer was 14% statewide, and prevalence and geographic range had increased since the early 1990 s. Natural woodlands provided the best habitat for intermediate hosts, and increases in prevalence of infection in deer may be due to recent patterns in growing-season precipitation. This study has redefined the geographic distribution of meningeal worm infection and increased understanding of how climate and habitat influence the prevalence and distribution of this parasite.


Assuntos
Cervos/parasitologia , Infecções por Strongylida/veterinária , Estrongilídios , Animais , Animais Selvagens/parasitologia , Clima , Ecossistema , North Dakota/epidemiologia , Prevalência , Infecções por Strongylida/epidemiologia , Infecções por Strongylida/parasitologia
19.
Diabetes Care ; 38(4): 620-7, 2015 04.
Artigo em Inglês | MEDLINE | ID: mdl-25583752

RESUMO

OBJECTIVE: Little is known about arsenic metabolism in diabetes development. We investigated the prospective associations of low-moderate arsenic exposure and arsenic metabolism with diabetes incidence in the Strong Heart Study. RESEARCH DESIGN AND METHODS: A total of 1,694 diabetes-free participants aged 45-75 years were recruited in 1989-1991 and followed through 1998-1999. We used the proportions of urine inorganic arsenic (iAs), monomethylarsonate (MMA), and dimethylarsinate (DMA) over their sum (expressed as iAs%, MMA%, and DMA%) as the biomarkers of arsenic metabolism. Diabetes was defined as fasting glucose ≥ 126 mg/dL, 2-h glucose ≥ 200 mg/dL, self-reported diabetes history, or self-reported use of antidiabetic medications. RESULTS: Over 11,263.2 person-years of follow-up, 396 participants developed diabetes. Using the leave-one-out approach to model the dynamics of arsenic metabolism, we found that lower MMA% was associated with higher diabetes incidence. The hazard ratios (95% CI) of diabetes incidence for a 5% increase in MMA% were 0.77 (0.63-0.93) and 0.82 (0.73-0.92) when iAs% and DMA%, respectively, were left out of the model. DMA% was associated with higher diabetes incidence only when MMA% decreased (left out of the model) but not when iAs% decreased. iAs% was also associated with higher diabetes incidence when MMA% decreased. The association between MMA% and diabetes incidence was similar by age, sex, study site, obesity, and urine iAs concentrations. CONCLUSIONS: Arsenic metabolism, particularly lower MMA%, was prospectively associated with increased incidence of diabetes. Research is needed to evaluate whether arsenic metabolism is related to diabetes incidence per se or through its close connections with one-carbon metabolism.


Assuntos
Arsênico/metabolismo , Arsênico/toxicidade , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/metabolismo , Exposição Ambiental/estatística & dados numéricos , Índios Norte-Americanos/estatística & dados numéricos , Idoso , Arizona/epidemiologia , Arsênico/urina , Biomarcadores/metabolismo , Biomarcadores/urina , Estudos de Coortes , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/urina , Exposição Ambiental/efeitos adversos , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Incidência , Masculino , Pessoa de Meia-Idade , North Dakota/epidemiologia , Oklahoma/epidemiologia , Estudos Prospectivos , South Dakota/epidemiologia
20.
Appl Environ Microbiol ; 81(1): 48-58, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25304515

RESUMO

Scant attention has been paid to Lyme disease, Borrelia burgdorferi, Ixodes scapularis, or reservoirs in eastern North Dakota despite the fact that it borders high-risk counties in Minnesota. Recent reports of B. burgdorferi and I. scapularis in North Dakota, however, prompted a more detailed examination. Spirochetes cultured from the hearts of five rodents trapped in Grand Forks County, ND, were identified as B. burgdorferi sensu lato through sequence analyses of the 16S rRNA gene, the 16S rRNA gene-ileT intergenic spacer region, flaB, ospA, ospC, and p66. OspC typing revealed the presence of groups A, B, E, F, L, and I. Two rodents were concurrently carrying multiple OspC types. Multilocus sequence typing suggested the eastern North Dakota strains are most closely related to those found in neighboring regions of the upper Midwest and Canada. BALB/c mice were infected with B. burgdorferi isolate M3 (OspC group B) by needle inoculation or tick bite. Tibiotarsal joints and ear pinnae were culture positive, and B. burgdorferi M3 was detected by quantitative PCR (qPCR) in the tibiotarsal joints, hearts, and ear pinnae of infected mice. Uninfected larval I. scapularis ticks were able to acquire B. burgdorferi M3 from infected mice; M3 was maintained in I. scapularis during the molt from larva to nymph; and further, M3 was transmitted from infected I. scapularis nymphs to naive mice, as evidenced by cultures and qPCR analyses. These results demonstrate that isolate M3 is capable of disseminated infection by both artificial and natural routes of infection. This study confirms the presence of unique (nonclonal) and infectious B. burgdorferi populations in eastern North Dakota.


Assuntos
Grupo Borrelia Burgdorferi/classificação , Grupo Borrelia Burgdorferi/isolamento & purificação , Variação Genética , Roedores/microbiologia , Estruturas Animais/microbiologia , Animais , Proteínas de Bactérias/genética , Grupo Borrelia Burgdorferi/genética , Análise por Conglomerados , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Modelos Animais de Doenças , Transmissão de Doença Infecciosa , Coração/microbiologia , Ixodes , Doença de Lyme/epidemiologia , Camundongos Endogâmicos BALB C , Dados de Sequência Molecular , Tipagem de Sequências Multilocus , North Dakota/epidemiologia , Filogenia , RNA Ribossômico 16S/genética , Reação em Cadeia da Polimerase em Tempo Real , Análise de Sequência de DNA , Spirochaetales , Carrapatos/microbiologia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA