An Exploration of Colorectal Cancer Incidence Rates in North Dakota, USA, via Structural Equation Modeling

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 \u3c 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

Level I Fieldwork Using Simulation: Student Performance Outcomes and Perceptions

The purpose of this study was to examine students’ perceptions and performance outcomes of a virtual fieldwork using Simucase® in conjunction with supplemental activities and debriefing opportunities. The simulation replaced Level I clinic-based fieldwork experiences that were cancelled due to COVID-19. Quantitative and qualitative data were collected using a modified evaluation tool to assess student performance outcomes and perceptions for students in the Year one Occupational Therapy Doctorate (OTD) cohort (n=57) and the Year two Master of Occupational Therapy (MOT) cohort (n=57) enrolled in a public university in the rural Midwest. Student ratings were compared using chi-square test of independence statistics and correlations with faculty ratings were estimated using Spearman’s correlation. Findings suggest that students performed high in most areas for six professional behaviors and five professional skills. Creswell and Creswell’s (2018) approach was used to analyze and compare student perceptions within cohorts to establish themes. Six themes were identified in students’ skill set and confidence with virtual fieldwork, and two themes were identified for ways to enhance the experience

Exploring Clinical Risk Factors for Breast Cancer among American Indian Women

Objective: Very little is known about the breast cancer risk profile among American Indian women. Previous research shows that the proportion of American Indian/Alaska Native women with baseline characteristics (commonly known breast cancer risk factors) differs from other ethnicities. This retrospective case control study was designed to the explore the association of these factors among American Indian women with and without breast cancer. Methods: Cases and controls were retrospectively selected from the medical records of American Indian women who obtained their health care from Quentin N. Burdick Memorial Health Care Facility (IHS) in Belcourt, ND. For each woman with breast cancer (n=141), two controls were selected when possible (n=278). Risk factors examined included woman’s age, age at first live birth, age of menarche, the number of previous benign breast biopsies, the total number of first-degree relatives with breast cancer, body mass index and parity. Odds ratios and 95% confidence intervals were calculated using logistic regression. Results: Many of the associations found among American Indian women who obtained their health care from Quentin N. Burdick Memorial Health Care Facility (IHS) in Belcourt, ND, between risk factors commonly identified in other populations and breast cancer were weakly positive. Nulliparity was the only risk factor to consistently show a positive significant association (OR = 2.87, 95% CI 1.16-.7.12). Conclusion: Disparities in breast cancer incidence, mortality and screening among Northern Plains American Indian emphasize the need to better understand the risk factors associated with breast cancer in this population. Based on the results of this study, the value of current risk prediction models in American Indian communities is uncertain and clinicians should be cautious in using these models to inform American Indian patients of their risk for breast cancer

Collaborative Fieldwork Supervision Model Supports Identified by Occupational Therapy Fieldwork Educators

Within the occupational therapy (OT) profession, the collaborative fieldwork supervision model is considered a non-traditional approach to fieldwork education. Although supportive strategies for fieldwork education have been developed, there is little data to validate fieldwork educators\u27 perspectives on the value and helpfulness of these supports for this model. Using a mixed-methods research design, this study aimed to identify what supports influenced fieldwork educators to use the collaborative fieldwork supervision model, what supports are valued when implementing it, and what supports would be considered helpful for those who have not used it. A total of 382 fieldwork educators completed the study, with 113 who identified as model users and 269 who identified as model non-users. Four themes emerged from model users that influenced their decision to use the model: support from 1) fieldwork site context, 2) academic program, 3) student engagement, and 4) professional resources. Based on the study results, a four-part approach is recommended for educational programs to support the initiation and use of the collaborative fieldwork supervision model

Occupational Therapy Practice Patterns In Two Rural States: Does The College Experience Influence Rural Employment Choice?

An online survey was conducted of 225 occupational therapy (OT) practitioners living in the rural states of North Dakota and Wyoming to explore practice patterns and the influence of the college experience on employment choice. Findings showed that rural practitioners had greater variability of hours spent working (5.5 more hours per week, p=.028), and one more work location on average (p=.006). Therapists in urban settings spent 15% more time in fieldwork education than their rural counterparts (p=.021). Rural practice choice was influenced by participation in Level I and Level II fieldwork (p=.002) but not by loan debt. Study implications for academic programs include focusing on multiple areas of practice in the curriculum design, and exposure of students to rural practitioners and rural practice examples/experiences. Recommendations were made for rural fieldwork educator training and employer support of rural fieldwork education. Further study of the experience of working within a rural practice context as a student and OT practitioner are recommended, including variables impacting rural practitioner work with fieldwork students, and student interest in rural fieldwork placement

Level II Fieldwork Educators\u27 Perceived and Experienced Challenges with Using the Collaborative Fieldwork Supervision Model

Fieldwork shortages have been noted in the literature for some time. With the ever-changing healthcare system and an increasing number of students in occupational therapy programs, the scarcity of fieldwork placements is dire. Rooted in adult learning principles, the collaborative fieldwork supervision model is one approach to fieldwork education that may alleviate the shortage of placements, while also supporting student learning. This model is designed to have one fieldwork educator supervising two or more students throughout a fieldwork experience. The strengths and challenges of this model are well documented, although it is unclear if the identified challenges are the same or different for those who have and have not used the model. Therefore, a research study was conducted to investigate Level II fieldwork educators’ experienced and perceived challenges of the collaborative fieldwork supervision model. Narrative data was gathered from both fieldwork educators who have used the model and those who have not used the model, within the last five years. The researchers investigated two open-ended questions from a nationwide survey disseminated in 2018. Nearly 30% of the study respondents reported having used the model, while 70% reported not using the model. The same five themes emerged from both groups, however, the prevalence and subthemes between the two groups were different. The themes are: 1) considerations at fieldwork site; 2) knowledge, skill, and professionalism of students; 3) client needs and level of comfort; 4) fieldwork educator knowledge and familiarity with model; and 5) culture of fieldwork education. Methods for addressing challenges and implications for occupational therapy education are discussed

A Profile of Tribal Health Departments

This study uses data to analyze the impacts of Tribal health departments in improving health status and reducing health disparities.

Screening for fetal alcohol spectrum disorder in infants and young children

Introduction: With an estimated prevalence of up to five percent in the general population, fetal alcohol spectrum disorders (FASD) are the most common neurodevelopmental disorder and more prevalent than autism. Early identification and subsequent early intervention have the potential to improve developmental trajectory of children with FASD. In addition, new research suggests supplementation with choline may ameliorate the developmental impairments associated with prenatal alcohol exposure. Availability of a screening tool with acceptable epidemiologic performance criteria may be clinical useful in identification of young children at increased risk for FASD. In this paper we describe the Early Fetal Alcohol Spectrum Disorder Screening Test (E-FAST) to identify young children at increased risk for an FASD.Methods: We developed the E-FAST dataset from previously published studies, comprised of 281 children under 5 years of age, 180 (64.1%) were diagnosed with FASD and 101 (35.9%) were non-FASD.Analysis: The analysis identified seven useful variables (prenatal alcohol exposure, ADHD (Attention Deficit Hyperactivity Disorder), foster care or adopted, small OFC (occipital frontal circumference), communication impairments, impaired social skills, and cognitive deficits. All variables were categorized as yes/no for ease of use in a screening tool. Risk ratios for each of the seven indicators were estimated using two-way table analyses. Weights for each variable were estimated based on the relative strength of their odds ratios.Results: The average age was 2.7 years of age (S.D. 1.29) and ranged from infant (6.4%) to 4 years old (35.9%). Maternal alcohol use alone had a sensitivity of 0.97, specificity 0.65, and accuracy 0.86. For the combined seven variables, sensitivity was 0.94, specificity 0.74, and accuracy 0.87. Thus, the seven-item E-FAST screen had acceptable epidemiologic screening characteristics.Discussion: In the United States, up to 547 infants with FASD are born each day which far exceeds the capacity of multidisciplinary diagnostic clinics. During routine clinical management of infants and young children the use of an evidence-based screening tool provides a time efficient means to exclude large numbers of young children from further follow-up for FASD. Conversely, a positive screen identifies a smaller number of children at increased risk for FASD requiring more intensive evaluation and follow-up