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Introduction: Coronary heart disease (CHD) is the most common cardiovascular disease in the United States and heart disease is the leading cause of death in North Dakota. Although obesity is a major risk factor for CHD, some studies have reported an inverse relationship between body mass index (BMI) and CHD outcomes. Understanding the epidemiology of CHD among individuals with and without obesity is essential to guide health planning. Therefore, the objectives of this study were to estimate the prevalence and identify predictors of CHD among North Dakota adults with and without obesity., Methods: Behavioral Risk Factor Surveillance System data from 2017 to 2021 were provided by the North Dakota Department of Health and Human Services. Weighted prevalence estimates and 95% confidence intervals (CIs) were computed for CHD and potential risk factors among respondents with and without obesity (BMI ≥30 kg/m2). Multivariable logistic regression was used to identify significant predictors of CHD in both groups., Results: A total of 17,092 respondents were included in the study. Respondents with obesity had a higher prevalence of CHD (4.7%, 95% CI: 4.2-5.4) than those without obesity (3.0%, 95% CI: 2.7-3.4). Predictors of CHD among both groups included age, sex, self-reported general health, high blood pressure, high cholesterol, chronic obstructive pulmonary disease, and diabetes. Having a personal doctor (Odds Ratio [OR] = 1.91, 95% CI: 1.13-3.23) and arthritis (OR = 1.72, 95% CI: 1.34-2.22) were significant predictors of CHD among respondents without obesity, but not among those without obesity., Conclusion: While the prevalence of CHD was significantly higher among adults with obesity compared to those without obesity, the findings of the stratified analysis indicated that predictors of the condition tended to be similar for the two groups. This study provides useful information to guide health planning and control programs that aim to reduce the burden of CHD in North Dakota., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Mensah et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Mental health disparities exist between rural and metro areas of the United States. Differences in dietary intake may contribute to these disparities. We examined differences in dietary intake and mental health between those 50 years and older ( n = 637) living in rural counties to those living in metro counties in North Dakota and the relationship between dietary intake to days with depression or anxiety. A survey was conducted throughout North Dakota. Items were modified from other surveys, such as the Behavioral Risk Factor Surveillance System questionnaires and the National Health Interview Survey Cancer Control Supplement Dietary Screener Questionnaire. Comparing medians, individuals more likely to be unable to perform normal daily activities due to mental health ( p = 0.009) resided in rural areas instead of metro areas. Those living rurally also ate more processed meats ( p = 0.005), while trending toward less lean protein intake ( p = 0.056). Multinomial regression analyses controlling for covariates revealed that lean protein intake and fruit intake were inversely associated with days with depression and anxiety (all p < 0.05), whereas processed meat intake was positively associated with anxiety ( p = 0.005). Clinicians working with older adults residing in rural areas should emphasize substituting lean proteins for processed meats.

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., (© Wildlife Disease Association 2024.)

Chronic wasting disease (CWD) is a contagious prion disease that affects cervids in North America, Northern Europe, and South Korea. CWD is spread through direct and indirect horizontal transmission, with both clinical and preclinical animals shedding CWD prions in saliva, urine, and feces. CWD particles can persist in the environment for years, and soils may pose a risk for transmission to susceptible animals. Our study presents a sensitive method for detecting prions in the environmental samples of prairie soils. Soils were collected from CWD-endemic regions with high (Saskatchewan, Canada) and low (North Dakota, USA) CWD prevalence. Heat extraction with SDS-buffer, a serial protein misfolding cyclic amplification assay coupled with a real-time quaking-induced conversion assay was used to detect the presence of CWD prions in soils. In the prairie area of South Saskatchewan where the CWD prevalence rate in male mule deer is greater than 70%, 75% of the soil samples tested were positive, while in the low-prevalence prairie region of North Dakota (11% prevalence in male mule deer), none of the soils contained prion seeding activity. Soil-bound CWD prion detection has the potential to improve our understanding of the environmental spread of CWD, benefiting both surveillance and mitigation approaches.

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., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives. To assess COVID-19 vaccination rates among North Dakota residents who gave birth. Methods. We used data from North Dakota Vital Records and the North Dakota Immunization Information System for North Dakota residents who gave birth between April 1, 2021, and July 15, 2022. We evaluated vaccination with 1 dose, primary series, and monovalent booster for timing before and during pregnancy and postpartum. Results. Among North Dakota residents who gave birth, 44% received at least 1 COVID-19 vaccine, 34% received a complete primary series, and 10% received a monovalent booster dose. Among those who received a COVID-19 vaccine, the majority was vaccinated during pregnancy. Obstetrics and gynecology providers administered just 9.2% of COVID-19 vaccine doses. Conclusions. Most persons who gave birth in North Dakota did not receive the primary series of the COVID-19 vaccine while pregnant. Providers have an opportunity to counsel their pregnant and recently pregnant patients on vaccine recommendations. ( Am J Public Health. 2024;114(2):237-240. https://doi.org/10.2105/AJPH.2023.307500).

Context: Over-immunization, or administration of excess doses of vaccine, is an understudied topic in immunization. Adult over-immunization is particularly understudied, so building a basic understanding of the sources and scope of over-immunization is necessary to direct action., Objective: The aim of this evaluation was to quantify the extent of over-immunization in North Dakota's adult population from 2016 to 2021., Design: Records for all pneumococcal, zoster, and influenza vaccines administered to adults in North Dakota were extracted from the North Dakota Immunization Information System (NDIIS) from January 1, 2016, through December 31, 2021. The NDIIS is a state-wide immunization registry that captures all childhood and most adult immunizations., Setting: North Dakota., Participants: North Dakotan adults 19 years or older., Main Outcome Measure: The number and percentage of adults identified as over-immunized as well as the number and percentage of doses identified as an extra dose., Results: Frequency of over-immunization was less than 3% for all vaccines over the 6-year period assessed. Pharmacies and private practices were the most common sources of over-immunization of adults., Conclusions: These data show that over-immunization is still an issue in North Dakota, although the percentage of the adult population impacted is low. Reducing over-immunization is worth pursuing but should be balanced with the importance of improving low immunization coverage rates in the state. Improving utilization of the NDIIS by adult providers can help prevent over-immunization and under-immunization alike., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: The purpose of the present study was to characterize the incidence, injury characteristics, and outcomes of patients presented to a Level I adult trauma center in Fargo, North Dakota, with farm machinery injuries (FMI)., Methods: We performed a retrospective review of the trauma registry of Sanford Medical Center Fargo (SMCF) between January 2010 and December 2020. We compared admission characteristics of FMI admissions to non-FMI admissions, identified the types of machinery that are most commonly associated with FMI, and described the nature of these injuries by severity, anatomical site, type, age, sex, and length of stay (LoS). Injury severity was evaluated using Injury Severity Score (ISS)., Results: Findings indicated that FMI admissions had a higher mean ISS, longer ICU LoS, and a higher mortality rate than non-FMI admissions. The leading cause of fatal and non-fatal FMI in this region are tractors. Males experience 91.2% of tractor injuries, and individuals 65 and over account for nearly 53% of all tractor injuries (n = 18). Males accounted for all deaths, tractor and otherwise. The "other machinery" category was the second most common category and accounted for 50% of female patients. Additionally, 24.5% of all FMI are related to machine maintenance., Conclusion: The findings from this study indicate that FMI injuries represent a significant problem in the upper Midwest. Older, male farm workers experience a higher incidence of tractor-related injuries, and all tractor-related deaths occurred in individuals 65 years of age and older. These results underscore the need for further investigation into aging-related farm safety issues.

Objective: North Dakota (ND) had the highest coronavirus disease 2019 (COVID-19) case and mortality rate in the United States for nearly 2 mo. This study aims to compare 3 metrics ND used to guide public health action across its 53 counties., Methods: Daily COVID-19 case and death totals in North Dakota were evaluated using data from the COVID-tracker website provided by the North Department of Health (NDDoH). It was reported as: active cases per 10,000, tests administered per 10,000, and test positivity rate (the North Dakota health metric). The COVID-19 Response press conferences provided data for the Governor's metric. The Harvard model used daily new cases per 100,000. A chi-squared test was used to compare differences in these 3 metrics on July 1, August 26, September 23, and November 13, 2020., Results: On July 1, no significant difference between the metrics was found. By September 23, Harvard's health metric indicated critical risk while ND's health metric was moderate risk, and the Governor's metric was still low risk., Conclusions: ND's and the Governor's metric underrepresented the risk of the COVID-19 outbreak in North Dakota. The Harvard metric reflected North Dakota's increasing risk; it should be considered as a national standard in future pandemics., Public Health Implications: Model-based predictors could guide policy-makers to effectively control spread of infectious disease; proactive models could reduce risk of disease as it progresses in vulnerable communities.

Background: COVID-19 is an important public health concern due to its high morbidity, mortality and socioeconomic impact. Its burden varies by geographic location affecting some communities more than others. Identifying these disparities is important for guiding health planning and service provision. Therefore, this study investigated geographical disparities and temporal changes of the percentage of positive COVID-19 tests and COVID-19 incidence risk in North Dakota., Methods: COVID-19 retrospective data on total number of tests and confirmed cases reported in North Dakota from March 2020 to September 2021 were obtained from the North Dakota COVID-19 Dashboard and Department of Health, respectively. Monthly incidence risks of the disease were calculated and reported as number of cases per 100,000 persons. To adjust for geographic autocorrelation and the small number problem, Spatial Empirical Bayesian (SEB) smoothing was performed using queen spatial weights. Identification of high-risk geographic clusters of percentages of positive tests and COVID-19 incidence risks were accomplished using Tango's flexible spatial scan statistic. ArcGIS was used to display and visiualize the geographic distribution of percentages of positive tests, COVID-19 incidence risks, and high-risk clusters., Results: County-level percentages of positive tests and SEB incidence risks varied by geographic location ranging from 0.11% to 13.67% and 122 to 16,443 cases per 100,000 persons, respectively. Clusters of high percentages of positive tests were consistently detected in the western part of the state. High incidence risks were identified in the central and south-western parts of the state, where significant high-risk spatial clusters were reported. Additionally, two peaks (August 2020-December 2020 and August 2021-September 2021) and two non-peak periods of COVID-19 incidence risk (March 2020-July 2020 and January 2021-July 2021) were observed., Conclusion: Geographic disparities in COVID incidence risks exist in North Dakota with high-risk clusters being identified in the rural central and southwest parts of the state. These findings are useful for guiding intervention strategies by identifying high risk communities so that resources for disease control can be better allocated to communities in need based on empirical evidence. Future studies will investigate predictors of the identified disparities so as to guide planning, disease control and health policy., (© 2023. The Author(s).)

Background: The 2019 overall breastfeeding initiation rate in the US was 84.1%, yet only 76.6% of American Indian (AI) women initiated breastfeeding. In North Dakota (ND), AI women have greater exposure to interpersonal violence than other racial/ethnic groups. Stress associated with interpersonal violence may interfere with processes important to breastfeeding. We explored whether interpersonal violence partially explains racial/ethnic disparities in breastfeeding in ND., Methods: Data for 2161 women were drawn from the 2017-2019 ND Pregnancy Risk Assessment Monitoring System. Breastfeeding questions in PRAMS have been tested among diverse populations. Breastfeeding initiation was self-report to "Did you ever breastfeed or pump breast milk to feed your new baby, even for a short period?" (yes/no). Breastfeeding duration (2 months; 6 months) was self-reported how many weeks or months of breastmilk feeding. Interpersonal violence for both 12 months before and during pregnancy based on self-report (yes/no) of violence from a husband/partner, family member, someone else, or ex-husband/partner. An "Any violence" variable was created if participants reported "yes" to any violence. Logistic regression models estimated crude and adjusted odds ratios (OR) and 95% confidence intervals (95% CI) for breastfeeding outcomes among AI and Other Race women compared to White women. Sequential models were adjusted for interpersonal violence (husband/partner, family member, someone else, ex-husband/partner, or any)., Results: AI women had 45% reduced odds of initiating breastfeeding (OR: 0.55, 95% CI: 0.36, 0.82) compared to white women. Including interpersonal violence during pregnancy did not change results. Similar patterns were observed for all breastfeeding outcomes and all interpersonal violence exposures., Discussion: Interpersonal violence does not explain the disparity in breastfeeding in ND. Considering cultural ties to the tradition of breastfeeding and the role of colonization may provide a better understanding of breastfeeding among AI populations.

Background: Although the burden of the coronavirus disease 2019 (COVID-19) has been different across communities in the US, little is known about the disparities in COVID-19 burden in North Dakota (ND) and yet this information is important for guiding planning and provision of health services. Therefore, the objective of this study was to identify geographic disparities of COVID-19 hospitalization risks in ND., Methods: Data on COVID-19 hospitalizations from March 2020 to September 2021 were obtained from the ND Department of Health. Monthly hospitalization risks were computed and temporal changes in hospitalization risks were assessed graphically. County-level age-adjusted and spatial empirical Bayes (SEB) smoothed hospitalization risks were computed. Geographic distributions of both unsmoothed and smoothed hospitalization risks were visualized using choropleth maps. Clusters of counties with high hospitalization risks were identified using Kulldorff's circular and Tango's flexible spatial scan statistics and displayed on maps., Results: There was a total of 4,938 COVID-19 hospitalizations during the study period. Overall, hospitalization risks were relatively stable from January to July and spiked in the fall. The highest COVID-19 hospitalization risk was observed in November 2020 (153 hospitalizations per 100,000 persons) while the lowest was in March 2020 (4 hospitalizations per 100,000 persons). Counties in the western and central parts of the state tended to have consistently high age-adjusted hospitalization risks, while low age-adjusted hospitalization risks were observed in the east. Significant high hospitalization risk clusters were identified in the north-west and south-central parts of the state., Conclusions: The findings confirm that geographic disparities in COVID-19 hospitalization risks exist in ND. Specific attention is required to address counties with high hospitalization risks, especially those located in the north-west and south-central parts of ND. Future studies will investigate determinants of the identified disparities in hospitalization risks., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Khan, Deb Nath, Schmidt, Njau and Odoi.)

Objective: This study investigates the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission potential in North Dakota, South Dakota, Montana, Wyoming, and Idaho from March 2020 through January 2021., Methods: Time-varying reproduction numbers, R t , of a 7-d-sliding-window and of non-overlapping-windows between policy changes were estimated using the instantaneous reproduction number method. Linear regression was performed to evaluate if per-capita cumulative case-count varied across counties with different population size or density., Results: The median 7-d-sliding-window R t estimates across the studied region varied between 1 and 1.25 during September through November 2020. Between November 13 and 18, R t was reduced by 14.71% (95% credible interval, CrI, [14.41%, 14.99%]) in North Dakota following a mask mandate; Idaho saw a 1.93% (95% CrI [1.87%, 1.99%]) reduction and Montana saw a 9.63% (95% CrI [9.26%, 9.98%]) reduction following the tightening of restrictions. High-population and high-density counties had higher per-capita cumulative case-count in North Dakota on June 30, August 31, October 31, and December 31, 2020. In Idaho, North Dakota, South Dakota, and Wyoming, there were positive correlations between population size and per-capita weekly incident case-count, adjusted for calendar time and social vulnerability index variables., Conclusions: R t decreased after mask mandate during the region's case-count spike suggested reduction in SARS-CoV-2 transmission.

Antimicrobials are critical for medicine, but the problem of antimicrobial resistance (AMR) threatens the effectiveness of these valuable drugs. In USA, there are no national- or state-level programs or policies in place to track antibiotic use (AU) in dogs, cats, and horses, despite acknowledgement of this sector's importance to both the AMR problem and its solution. AU measurement is a key part of antibiotic stewardship and AMR prevention. This study aimed to fill existing gaps in the veterinary professions' knowledge of antibiotic prescribing in small animals and horses. To address this aim, medical record data were collected on a single day per quarter for 1 year from 19 Minnesota and North Dakota small animal and equine practices, totaling 1,899 veterinarian consults of dogs, cats, and horses. Overall, 25.8% of all canine, feline, and equine consults involved an antibiotic prescription. Third-generation cephalosporins were the most commonly prescribed systemic antibiotic drug class, and the long-acting injectable drug, cefovecin, was the most commonly prescribed antibiotic for cats (34.5%). Topical antibiotic preparations were prescribed frequently, especially in dogs (42.5% of canine prescriptions), though systemic antibiotics were often prescribed concurrently. Common general indications, based on problem or diagnosis recorded in the medical record, for antibiotics in all species combined were skin conditions (24.4%), otitis (22.1%), ophthalmic (9.4%), gastrointestinal (8.3%), respiratory (8.3%), and urinary tract (7.6%) diseases. While 44.2% of patients for which antibiotics were prescribed had cytology performed, only 3.9% had bacterial culture and susceptibility performed. In a pre-study survey, veterinarians' recommendations for AU differed from actual prescribing, suggesting collection of AU data provides more accurate assessments of veterinary prescribing behaviour than surveys. This study shows feasibility of AU measurement in small animals and horses. The data collection tool and standard operating procedures described prove suitable for national AU data collection., (© 2022 The Authors. Zoonoses and Public Health published by Wiley-VCH GmbH.)

Hepatic trematodes, such as Fasciola hepatica and Fascioloides magna , have variable distribution throughout the United States. F. magna is endemic in the upper midwestern United States, and F. magna infections are diagnosed frequently in weaned calves and adult beef cattle at the North Dakota State University Veterinary Diagnostic Laboratory (NDSU-VDL). Rarely, liver fluke infestation has also been observed in much younger calves, including aborted fetuses. We describe here, in 2 fetal and 7 neonatal beef calves submitted to the NDSU-VDL between 2011 and 2020, parasitic migration tracts in livers, consisting of regionally extensive, random, linear tracts of fibrosis admixed with black porphyrin pigment, along with foci of necrosis and hemorrhage, and mixed inflammatory cells, which were caused presumptively by F. magna infection. Samples were not available from our 9 cases for PCR assay and sequencing, but we did confirm F. magna within liver samples collected from regional cattle in 2020 and 2021. Fetal and neonatal trematodosis was often concurrent with other common causes of fetal abortion and neonatal calf loss in our cases; however, based on the prepatent period of F. magna , fetal and neonatal beef calf trematode infestations occurred in utero.

This retrospective cohort study was conducted to determine the prevalence of HCV infections among individuals incarcerated in a state prison system and identify potential contributing factors to HCV infection. North Dakota Department of Corrections and Rehabilitation (NDDOCR) data from 2009 to 2018 was used and period prevalence was calculated for this 10-year time period. The period prevalence of HCV infection was (15.13% (95% CI 14.39-15.90) with a marginally significant (p-value: 0.0542) increasing linear trend in annual prevalence over this period. Multivariate logistic regression analysis was used to identify risk factors associated with HCV infection. The main significant independent risk factors for HCV infection in this incarcerated population were age >40 years [OR: 1.78 (1.37-2.32)]; sex [OR: 1.21 (1.03-1.43)]; race/ethnicity [OR: 1.97 (1.69-2.29)]; history of intravenous drug use (IVDU) [OR: 7.36 (6.41-8.44)]; history of needle or syringe sharing [OR: 7.57 (6.62-8.67)]; and alcohol use [OR: 0.87 (0.77-0.99)]. Study limitations include uncollected information on sexual history, frequency or duration of injection drug use and blood transfusion history of the incarcerated population. Considering the high prevalence of HCV infection and its associated risk factors, it is important to implement prevention programs such as syringe/needle exchanges and counsel with imprisoned IVD users., Competing Interests: The authors have declared that no competing interests exist.

Rationale: Prior research has found adverse childhood experiences (ACEs) to be a risk factor for disability in adulthood. Moreover, accumulating evidence highlights that both ACEs and disability during pregnancy are a risk factor for both maternal and infant wellbeing. Yet, no previous work has assessed whether ACEs increase the risk of maternal disability., Objective: The current study assesses the link between maternal ACE exposure and disability., Methods: Data are from the North Dakota and South Dakota Pregnancy Risk Assessment Monitoring System (PRAMS), 2019 (N = 1775). Logistic regression was used to assess the relationship between accumulating ACEs and maternal disability., Results: Mothers with exposure to a greater number of ACE-notably, 4 or more ACEs- had elevated rates of several disabilities including difficulty communicating, difficulty remembering, difficulty seeing, and difficulty walking., Conclusions: Understanding the long-term health repercussions of ACEs for pregnant women and mothers is important to help inform the design and implementation of health care interventions. This study can be used to better understand the prevalence of disabilities among mothers and corroborate early life experiences as an important risk factor for disability., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Emerging research suggests that adverse childhood experiences (ACEs) may be a risk factor for prenatal marijuana use. This study is the first to use a representative sample from state surveillance systems to assess the connection between accumulating ACEs and marijuana use during pregnancy., Methods: Data are from the North Dakota and South Dakota Pregnancy Risk Assessment Monitoring System (PRAMS) from years 2017-2019 (N = 5399). The bivariate association between number of ACEs and marijuana use during pregnancy is assessed using a chi-square test. The multivariable association is assessed using linear probability modeling., Results: Only 0.9% of women with zero ACEs reported marijuana use during pregnancy, compared to 11.7% of women with four or more ACEs. Findings from linear probability models showed that mothers reporting two ACEs (b =0.023, 95% CI =0.003,.043), three ACEs (b =0.042, 95% CI =0.014,.069), and four or more ACEs (b =0.053, 95% CI =0.035,.071) are more likely to report marijuana use during pregnancy relative to those with zero ACEs, net of demographic and socioeconomic control variables., Conclusions: Accumulating maternal ACEs -especially four or more- is associated with increased likelihood of using marijuana during pregnancy. These findings demonstrate the early life trauma is a key social determinant of health over the life course and highlights how ACEs can contribute to intergenerational harm via the worsening of health behaviors during pregnancy., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Ranaviruses are emerging pathogens that have caused mortality events in amphibians worldwide. Despite the negative effects of ranaviruses on amphibian populations, monitoring efforts are still lacking in many areas, including in the Prairie Pothole Region (PPR) of North America. Some PPR wetlands in Montana and North Dakota (USA) have been contaminated by energy-related saline wastewaters, and increased salinity has been linked to greater severity of ranavirus infections. In 2017, we tested tissues from larvae collected at 7 wetlands that ranged in salinity from 26 to 4103 mg Cl l-1. In 2019, we used environmental DNA (eDNA) to test for ranaviruses in 30 wetlands that ranged in salinity from 26 to 11754 mg Cl l-1. A previous study (2013-2014) found that ranavirus-infected amphibians were common across North Dakota, including in some wetlands near our study area. Overall, only 1 larva tested positive for ranavirus infection, and we did not detect ranavirus in any eDNA samples. There are several potential reasons why we found so little evidence of ranaviruses, including low larval sample sizes, mismatch between sampling and disease occurrence, larger pore size of our eDNA filters, temporal variation in outbreaks, low host abundance, or low occurrence or prevalence of ranaviruses in the wetlands we sampled. We suggest future monitoring efforts be conducted to better understand the occurrence and prevalence of ranaviruses within the PPR.

Background: Blood pressure variability (BPV) describes visit-to-visit blood pressure (BP) changes independent of hypertension. Preoperative BPV and intraoperative BPV are associated with increased postoperative outcomes. We investigated the impact of both preoperative BPV and intraoperative BPV on elective surgical outcomes, specifically whether preoperative BPV and intraoperative BPV were independent risk factors for surgical complications., Materials and Methods: We investigated 600 patients undergoing elective surgery lasting more than two h and who had ≥8 outpatient BP recordings over three preoperative years. Age, sex, ethnicity, BMI, current medical problems, and medications at time of surgery were recorded. BPV was calculated as the standard deviation (SD) of systolic or diastolic BP for the 369 valid patients. Average BPV were compared between adverse outcomes of readmission, wound infection, acute kidney injury, death, myocardial infarction, and cerebral vascular accident., Results: Three-hundred-sixty-nine (52.6% male, 47.4% female, 98.1% non-Hispanic) patients (mean age 62.5) were included in the study. Preoperative systolic (P = 0.043) and diastolic (P = 0.009) BPV were higher for patients with the combined endpoint of all adverse events. Preoperative systolic BPV was correlated with intraoperative BPV (P = 0.010). Both systolic and diastolic preoperative BPV was found to be independent from intraoperative BPV. Otolaryngology procedures were associated with less adverse outcomes (P = 0.034), whil antimicrobials (P = 0.022), autonomic drugs (P < 0.001), or respiratory drugs (P = 0.032) was associated with an increased likelihood of adverse outcome., Conclusion: Preoperative DBPV is associated with increased risk of readmission, wound infection and the combined endpoint of all adverse events. Intraoperative systolic blood pressure variability (SPBV) is associated with increased risk of acute kidney injury and the combined endpoint of all adverse events. Preoperative DBPV and intraoperative SBPV are independent risk factors for ninety-d postoperative outcomes. BPV should be considered in individualized risk assessment when assessing patient eligibility for elective procedures., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Importance: Prenatal smoking is a known modifiable risk factor for stillbirth; however, the contribution of prenatal drinking or the combination of smoking and drinking is uncertain., Objective: To examine whether prenatal exposure to alcohol and tobacco cigarettes is associated with the risk of stillbirth., Design, Setting, and Participants: The Safe Passage Study was a longitudinal, prospective cohort study with data collection conducted between August 1, 2007, and January 31, 2015. Pregnant women from Cape Town, South Africa, and the Northern Plains region of the US were recruited and followed up throughout pregnancy. Data analysis was performed from November 1, 2018, to November 20, 2020., Exposure: Maternal consumption of alcohol and tobacco cigarettes in the prenatal period., Main Outcomes and Measures: The main outcomes were stillbirth, defined as fetal death at 20 or more weeks' gestation, and late stillbirth, defined as fetal death at 28 or more weeks' gestation. Self-reported alcohol and tobacco cigarette consumption was captured at the recruitment interview and up to 3 scheduled visits during pregnancy. Participants were followed up during pregnancy to obtain delivery outcome., Results: Of 11663 pregnancies (mean [SD] gestational age at enrollment, 18.6 [6.6] weeks) in 8506 women for whom the pregnancy outcome was known by 20 weeks' gestation or later and who did not terminate their pregnancies, there were 145 stillbirths (12.4 per 1000 pregnancies) and 82 late stillbirths (7.1 per 1000 pregnancies). A total of 59% of pregnancies were in women from South Africa, 59% were in multiracial women, 23% were in White women, 17% were in American Indian women, and 0.9% were in women of other races. A total of 8% were older than 35 years. In 51% of pregnancies, women reported no alcohol or tobacco cigarette exposure (risk of stillbirth, 4 per 1000 pregnancies). After the first trimester, 18% drank and smoked (risk of stillbirth, 15 per 1000 births), 9% drank only (risk of stillbirth, 10 per 1000 pregnancies), and 22% smoked only (risk of stillbirth, 8 per 1000 pregnancies). Compared with the reference group (pregnancies not prenatally exposed or without any exposure after the first trimester), the adjusted relative risk of late stillbirth was 2.78 (98.3% CI, 1.12-6.67) for pregnancies prenatally exposed to drinking and smoking, 2.22 (98.3% CI, 0.78-6.18) for pregnancies prenatally exposed to drinking only after the first trimester, and 1.60 (98.3% CI, 0.64-3.98) for pregnancies prenatally exposed to smoking only after the first trimester. The adjusted relative risk for all stillbirths was 1.75 (98.3% CI, 0.96-3.18) for dual exposure, 1.26 (98.3% CI, 0.58-2.74) for drinking only, and 1.27 (98.3% CI, 0.69-2.35) for smoking only compared with the reference group., Conclusions and Relevance: These results suggest that combined drinking and smoking after the first trimester of pregnancy, compared with no exposure or quitting before the end of the first trimester, may be associated with a significantly increased risk of late stillbirth.

Introduction: Hepatitis C virus (HCV) infection is a public health epidemic. People who inject drugs (PWID) are at high risk for transmitting and contracting HCV. The objective of this study was to assess the effectiveness of a multifaceted intervention at a federally qualified health center in the US Midwest to improve HCV screening rates among PWID., Methods: A prospective quality improvement initiative was conducted to increase the proportion of PWID screened for HCV. Inclusion criteria consisted of being seen by a primary care provider from April 16, 2019, through February 28, 2020, being aged 18 years or older, and confirmation of intravenous drug use. PWID status was confirmed by reviewing electronic health records. The multifaceted intervention consisted of educational sessions for the health care team and workflow changes. We analyzed the proportion of patients screened preintervention and postintervention by using χ 2 tests., Results: Of 742 patients who met the inclusion criteria, the proportion of PWID screened preintervention was 59.6% (n = 329) and the proportion of PWID screened postintervention was 65.1% (n = 283), increasing the screening rate by 5.5 percentage points. A χ 2 test of homogeneity indicated a significant relationship between the preintervention and postintervention periods, and screening outcomes (P < .001)., Conclusion: This multifaceted intervention to increase HCV screening resulted in a modest increase in the proportion of PWID screened. Consistent and health care system-wide screening approaches are needed to optimize the potential of HCV treatment and cure options now available.

Forty female moose (Alces alces) captured in North Dakota, US, in March 2014 were tested for antibodies to a variety of pathogens. Antibodies to West Nile virus (WNV) were detected in 39 (98%) moose following a year with a high number of human cases, suggesting the population accurately reflects WNV activity. Fifteen percent of moose (6/40) had antibodies to Borrelia burgdorferi, implying expansion of the tick vector into the area. Antibodies to Anaplasma spp. were detected in 55% of moose (22/40), a higher rate than previously detected in cattle from the region. Low titers (100-400) to one or more serovars of Leptospira spp. were detected in 23% of moose (9/40), a common finding in wild ruminants. Exposure to other pathogens was uncommon (<8%; <3/40) or not documented. Survival and recruitment were high during the study period, suggesting a limited population-level impact at current levels of exposure and environmental co-stressors., (© Wildlife Disease Association 2021.)

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of the coronavirus disease 2019 (COVID-19) pandemic, has disrupted much of the health care system. Despite changes in routine practices, community pharmacists have continuously served their patients throughout the pandemic. Frontline health care workers, including community pharmacy personnel, are at risk of becoming infected with SARS-CoV-2., Objective: The purpose of this observational study was to report the prevalence of antibodies to SARS-CoV-2 from a sample of North Dakota community pharmacy personnel., Methods: This observational study was conducted in 2 cities in North Dakota with the highest COVID-19 rates at the time of investigation. Community pharmacy personnel were tested for the presence of the SARS-CoV-2 IgG and IgM antibodies using a rapid antibody test. In addition to antibody testing, participants completed a questionnaire reporting on demographics, previous COVID-19 exposure, previous COVID-19 symptoms, and personal protection equipment (PPE) practices., Results: A total of 247 pharmacy personnel from 29 pharmacies were tested for SARS-CoV-2 antibodies. The timing and use of PPE varied by location. Among the 247 community pharmacy personnel, 14.6% tested positive for IgM, IgG, or both. Survey data revealed a statistically significant association (P < 0.05) between a positive antibody test and direct contact with an individual who tested positive for COVID-19 (odds ratio: 2.65 [95% CI: 1.18-5.95]), but there were no statistically significant effects related to the workplace, including PPE use, personnel role, or the number of hours worked. The self-reported loss of taste or smell was the only significant symptom associated with a positive antibody test (18.91 [3.10-115.59])., Conclusion: Community pharmacy personnel may be at an increased risk for SARS-CoV-2 exposure compared with the general population., (Copyright © 2021 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Competing Interests: All authors have completed and submitted the International Committee of Medical Journal Editors form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

Background: Oil development (OD) has been associated with increased sexually transmitted infection (STI) rates, with limited focus on the North Dakota (ND) oil boom. Public health (PH) nurse experiences can provide context related to health challenges during OD-related population booms., Objective: To compare reported STI rates in ND oil-producing (OP) and non-oil-producing (NOP) counties before, during, and after the oil boom and describe PH nurse experiences during this time., Design: We conducted secondary data analysis of oil production data and reported rates for chlamydia and gonorrhea, and conducted interviews with ND PH nurses., Sample: PH nurses within ND counties geographically located in or near OD in the state., Measurements: ND county-level OD data trends were compared to similarly timed reported rates of chlamydia and gonorrhea in OP and NOP counties. PH nurse interviews were conducted addressing their STI-related experiences working in PH during the oil boom., Results: Significant findings include a correlation between OD and gonorrhea rates. PH nurses described a limited PH infrastructure to meet the health needs of a transient, increasing population., Conclusions: Expanding the role of PH nurses in ND to implement STI screening and treatment would improve access to STI testing allowing for comprehensive reporting of STIs., (© 2020 Wiley Periodicals, Inc.)

Antimicrobial resistance (AMR) is a well-documented phenomenon in bacteria from many natural ecosystems, including wild animals. However, the specific determinants and spatial distribution of resistant bacteria and antimicrobial resistance genes (ARGs) in the environment remain incompletely understood. In particular, information regarding the importance of anthropogenic sources of AMR relative to that of other biological and ecological influences is lacking. We conducted a cross-sectional study of AMR in great horned owls ( Bubo virginianus ) and barred owls ( Strix varia ) admitted to a rehabilitation center in the midwestern United States. A combination of selective culture enrichment and shotgun metagenomic sequencing was used to identify ARGs from Enterobacteriaceae Overall, the prevalence of AMR was comparable to that in past studies of resistant Enterobacteriaceae in raptors, with acquired ARGs being identified in 23% of samples. Multimodel regression analyses identified seasonality and owl age to be important predictors of the likelihood of the presence of ARGs, with birds sampled during warmer months being more likely to harbor ARGs than those sampled during cooler months and with birds in their hatch year being more likely to harbor β-lactam ARGs than adults. Beyond host-specific determinants, ARG-positive owls were also more likely to be recovered from areas of high agricultural land cover. Spatial clustering analyses identified a significant high-risk cluster of tetracycline resistance gene-positive owls in the southern sampling range, but this could not be explained by any predictor variables. Taken together, these results highlight the complex distribution of AMR in natural environments and suggest that both biological and anthropogenic factors play important roles in determining the emergence and persistence of AMR in wildlife. IMPORTANCE Antimicrobial resistance (AMR) is a multifaceted problem that poses a worldwide threat to human and animal health. Recent reports suggest that wildlife may play an important role in the emergence, dissemination, and persistence of AMR. As such, there have been calls for better integration of wildlife into current research on AMR, including the use of wild animals as biosentinels of AMR contamination in the environment. A One Health approach can be used to gain a better understanding of all AMR sources and pathways, particularly those at the human-animal-environment interface. Our study focuses on this interface in order to assess the effect of human-impacted landscapes on AMR in a wild animal. This work highlights the value of wildlife rehabilitation centers for environmental AMR surveillance and demonstrates how metagenomic sequencing within a spatial epidemiology framework can be used to address questions surrounding AMR complexity in natural ecosystems., (Copyright © 2020 American Society for Microbiology.)

Objectives: The objective of this study was to compare immunization rates of American Indian (AI) and White children in North Dakota and identify disparities in immunization rates by race., Study Design: The study design was to assess immunization coverage rates by race using immunization information system (IIS) data., Methods: Data from the North Dakota Immunization Information System (NDIIS) for children aged 19-35 months during quarter four of 2014, 2015, 2016, 2017 and 2018 were used to assess and compare immunization coverage rates for AI and White children. NDIIS data were also analyzed for timeliness of vaccine administration, Vaccines for Children (VFC) status, and the number of doses still needed to be considered up to date (UTD) with routinely recommended immunizations., Results: In quarter four of 2018 (Q4 2018), only 60% of AI children were UTD with the complete 4:3:1:3:3:1:4 vaccine series compared with 74.5% of White children of the same age. Fewer VFC-eligible AI children (59.1%) are UTD than VFC-eligible White children (68.7%). AI children were also more likely to be delayed at each immunization milestone, leading to fewer AI children to be UTD by 19 to 35 months of age., Conclusions: This study shows that there is a racial disparity in immunization coverage rates between AI and White children in North Dakota. Public health and private healthcare providers should work to identify and address barriers to vaccination and should implement strategies to increase immunization rates for AI children., (Copyright © 2020 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

The majority of available US-published reports present populations with community spread in urban areas. The objective of this report is to describe a rural healthcare system's utilisation of therapeutic options available to treat Coronavirus Disease 2019 (COVID-19) and subsequent patient outcomes. A total of 150 patients were treated for COVID-19 at three hospitals in the Dakotas from 21 March 2020 to 30 April 2020. The most common pharmacological treatment regimens administered were zinc, hydroxychloroquine plus azithromycin and convalescent plasma. Adjunctive treatments included therapeutic anticoagulation, tocilizumab and corticosteroids. As of 1 June 2020, 127 patients have survived to hospital discharge, 12 patients remain hospitalised and 11 patients have expired. The efficacy of hydroxychloroquine and azithromycin use has yet to be determined but was not without risks of corrected QT interval prolongation and arrhythmias in our cohort. We did not appreciate any adverse effects that appeared related to tocilizumab or convalescent plasma administration in those patient subsets. These findings may provide insight into disease severity and treatment options in the rural setting with limited resources to participate in clinical trials and encourage larger comparative studies evaluating treatment efficacy.

Introduction: Prenatal alcohol exposure is associated with adverse pregnancy outcomes such as fetal alcohol spectrum disorders. The study characterizes the pattern and risk factors of alcohol use during pregnancy for American Indian and Caucasian mothers in the Northern Plains., Methods: A general population of pregnant women was recruited from 5 sites, including 2,753 Caucasians and 2,124 American Indians (2006-2017). Alcohol consumption was based on self-report using a modified Timeline Followback interview, administered 3-4 times during pregnancy and 1 month postpartum. Risk for prenatal drinking was calculated using logistic regression models after controlling for demographics, reproductive history, prenatal care, mental health, and SES. The analysis was conducted in 2019., Results: More Caucasian mothers consumed alcoholic beverages during pregnancy than American Indians (63% vs 52%), whereas more American Indian mothers were binge drinkers than Caucasians (41% vs 28%). American Indian mothers had a lower risk of drinking in the second and third trimesters and postpartum, but a higher risk of binge drinking in the first trimester compared with Caucasians. Frequent relocation increased the risk of prenatal alcohol use among American Indian mothers, whereas age, marriage, income, parity, and fertility treatment affected the risk of prenatal drinking among Caucasian mothers., Conclusions: Alcohol use was more prevalent among Caucasian mothers. Among those who consumed alcohol during pregnancy, American Indian mothers consumed larger quantities. Change of residence was found to be the sole risk factor for prenatal drinking among American Indian mothers, whereas different and multiple risk factors were found for Caucasian mothers., (Copyright © 2020 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.)

Objectives: To evaluate the response of North Dakota health care providers to follow the recommendation set forth by the Advisory Committee on Immunization Practices (ACIP) to administer a dose of tetanus, diphtheria, and acellular pertussis (Tdap) vaccine to women during each pregnancy using the North Dakota Immunization Information System (NDIIS)., Methods: Data from the NDIIS for North Dakota infants born during calendar years 2013-2018 were extracted. Mother's name was taken from the newborn records and matched to NDIIS female client records to identify the population of mothers of newborns who would have been recommended to receive Tdap during their pregnancy. Doses of Tdap vaccine administered after October 1, 2012, were extracted from the NDIIS, and the dose records were matched back to the mother's record. The time from baby's birthdate back to the doses of Tdap vaccine administered to the mother was measured to find any doses that would have been administered during pregnancy., Results: The percentage of women receiving Tdap vaccine during pregnancy increased from 31.5% in 2013 to 60.6% in 2018. Of those women who received Tdap during pregnancy, 94% received the vaccine during the ACIP-recommended interval of 27 to 36 weeks' gestation, using the assumption that all babies were born at 40 weeks' gestation., Conclusions: North Dakota health care providers have responded positively to the recommendation of the ACIP to administer a dose of Tdap vaccine to women during each pregnancy and have increased their administration of the vaccine to their patients.

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.

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.

Patients residing in agricultural communities have a high risk of developing chronic kidney disease. In the Great Plains, geo-environmental risk factors (eg, variable climate, temperature, air quality, water quality, and drought) combine with agro-environmental risk factors (eg, exposure to fertilizers, soil conditioners, herbicides, fungicides, and pesticides) to increase risk for toxic nephropathy. However, research defining the specific influence of agricultural chemicals on the progression of kidney disease in rural communities has been somewhat limited. By linking retrospective clinical data within electronic medical records to environmental data from sources like US Environmental Protection Agency, analytical models are beginning to provide insight into the impact of agricultural practices on the rate of progression for kidney disease in rural communities., (Copyright © 2019 Elsevier Inc. All rights reserved.)

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.

Background: In Minnesota and North Dakota, a clonal strain of bla KPC-3 -producing Enterobacter cloacae complex has been reported with increasing frequency., Methods: Between July 2015 and February 2016, 13 carbapenem-resistant E. cloacae complex isolates were identified at our institution. Five bla KPC -positive isolates were identified by polymerase chain reaction and underwent pulsed-field gel electrophoresis and whole genome sequencing. Medical records of these patients were reviewed., Results: All 5 case-isolates belonged to sequence type 171 and were bla KPC-3 -positive. Three pulsed-field gel electrophoresis patterns with >90% similarity were identified in the 5 case-isolates. We identified overlaps in time and location between case patients. Plasmid types and resistance genes were nearly identical between the isolates. Whole genome sequencing showed isolates A, B, and D to be closely related with <10 core single-nucleotide polymorphisms differences. Isolates C and E were also closely related to each other, but more distantly to A, B, and D; all belonged to the clonal lineage of the major circulating E. cloacae complex strain in Minnesota and North Dakota. Despite having overlapping hospital stays, isolates for patients C and D were not identical., Conclusions: Isolates A and D were nearly identical, indicating possible transmission during hospitalization. Transmission of the other isolates may have occurred elsewhere. This report highlights the importance of using both epidemiologic and molecular data to track the spread of carbapenemase-producers., (Copyright © 2018 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.)

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.

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.

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., (© 2018 Wiley Periodicals, Inc.)

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., (© The Author 2016. Published by Oxford University Press on behalf of the Pediatric Infectious Diseases Society. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

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 (β = 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.

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., (Published by Elsevier Inc.)

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., (Copyright © 2016 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

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.

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., (© 2015 American Society for Nutrition.)

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.