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PubMedDate not supplied

Screening for spinal deformities in Minnesota schools.

Early detection of spine deformities by school screening has proven to be an effective mechanism for early diagnosis. The forward bending test is a simple rapid method of detection and has been used in the Minnesota State screening program. Screening in Minnesota began in 2 rural communities and spread to include the whole state. Over 570,000 children have been screened to the end of the 1975/1976 school year. The prevalence rate of 4.0% of rational prominences is the same as that found in other screening programs. The findings of a large number of small curves and the nearly equal sex ratio were unexpected, but reflect the recent literature. Even though a large number of normal spines are referred for physician evaluation by the screening, the benefits are great. The curves are detected when they are small, allowing progressive deformities to be detected early, promptly braced and deterioration prevented. The need for future surgical correction is thus decreased. The routine screening in Minnesota of school children for spine deformities has proved to be an effective method for the early detection of spine deformities. The screening test is rapid and easy--"a 30-second investment for a lifetime of dividends."

Braces↗
PubMedDate not supplied

Lyme disease in Minnesota: epidemiologic and serologic findings.

During the four years, 1980 to 1983, 83 Minnesota residents have been diagnosed with Lyme disease. Sixty-five of the patients were male. The median age of patients was 39 years with a range from one to 77 years. Seventy-five (90 percent) had onset in 1982 and 1983. Of these latter cases, 56 (75 percent) recalled a tick bite three to 27 days prior to the development of erythema chronicum migrans. Patients experienced possible exposure to Ixodes dammini in at least 24 (28 percent) of the 87 Minnesota counties; however, over 50 percent had reported exposure in one of eight east-central counties near or immediately west of the Wisconsin border. Serologic studies for antibody against the Ixodes dammini spirochete were completed on 30 patients with onset in 1982 and 1983. Of 28 patients with paired acute and convalescent serum samples, only two (7 percent) had fourfold rises in antibody titers. Lyme disease is an emerging public health problem in Minnesota. Additional studies are needed to define the risk of disease by geographic area within the state. Physicians statewide should be alert to the possibility of Lyme disease among their patients, since only 39 percent of patients with onset in 1982 and 1983 were exposed in their county of residence.

Adolescent↗
PubMed1995

Forecasting physician workforce requirements in Minnesota.

The existing oversupply, specialty imbalance, and geographic maldistribution of clinicians are inconsistent with the goals of health system reform in Minnesota. Health professional workforce projections can help the private and public sectors make informed decisions to assure that the future supply of health professionals reasonably approximates requirements. Appropriate methodologies for projecting national health professional requirements, based on existing HMO staffing patterns, should be applied to Minnesota. In the absence of workforce projections, a variety of assumptions about changes in Minnesota's health care system that will affect workforce supply and requirements can, nonetheless, be made. Limitations on the state's ability to influence the health professional workforce within its borders are noted.

Cost-Benefit Analysis↗
PubMed1995

Increasing incidence of gonorrhea--Minnesota, 1994.

In the United States, gonorrhea is an important cause of urethritis in men and cervicitis in women; reproductive complications include infertility and ectopic pregnancy. During 1981-1993, the annual incidence rate of gonorrhea in Minnesota declined; the average annual change in the rate of infection was -8.5% (Figure 1). However, in 1994, the incidence rate increased 32% (from 56 cases per 100,000 persons in 1993 to 74 cases per 100,000 in 1994). No corresponding increases occurred in rates of other reportable sexually transmitted diseases (STDs), including chlamydial infection and early syphilis. To elucidate possible explanations for the increased rate of gonorrhea in Minnesota in 1994, the Minnesota Department of Health (MDH) analyzed surveillance data for 1994 and compared it with data for 1993. This report presents the findings of the analysis.

Adolescent↗
PubMed1993

Family medicine in Minnesota: office costs and productivity.

Clinics representing more than half of Minnesota's family physicians participated in a statewide study on the practice of family medicine conducted by the Minnesota Academy of Family Physicians. The survey was designed to provide direction for individual physicians, administrators, and the Minnesota Academy of Family Physicians as an organization. The survey identified some concerns regarding access to care. In the central portion of the state, 71% of the full-time equivalent family physicians were in practices with Medicaid patient restrictions. In the most sparsely populated towns, 35% of the reporting family physicians who provided obstetrical care three years ago discontinued that service due to the cost or availability of professional liability coverage. Statewide in 1989, 57% of the family physician positions recruited for by the practices studies were unfilled at year's end, with 82% unfilled in the most sparsely populated areas.

Adult↗
PubMed1993

A study of Minnesota's high-risk health insurance pool.

This is a report of a study of Minnesota's high-risk health insurance pool for "medically uninsurable" persons. The study consisted of a survey of current and past enrollees carried out in the Spring of 1990 and an analysis of the claims and membership files for 1988 and 1989. The main policy conclusion we reached is that Minnesota's high-risk pool is an adequate approach to the problem raised by risk segmentation on the basis of health status, providing that enrollment remains a small fraction of the population. The recent high, enrollment growth rates the Minnesota risk pool has experienced raise the possibility that basic structural reforms of the nongroup and small-group health insurance markets are needed.

Adolescent↗
PubMed1995

Directions in HIV/AIDS research. A Minnesota perspective.

Clinical studies involving HIV therapeutics are becoming ever more challenging because of the changing epidemiology of HIV infection, the rapid evolution of standard clinical practice, and a more difficult economic environment for research. Recent studies relating to HIV pathogenesis have provided novel insights into the interactions between HIV, the immune system, and antiretroviral therapies. Current dogma now suggests that the interaction of HIV and the immune system is an incredibly dynamic process. HIV is an intimidating pathogen capable of replicating quickly and mutating very rapidly in response to antiretroviral therapy. An important question being studied by Minnesota-based investigators is how well plasma analysis reflects HIV-immune system interactions in the lymphoid tissue where most virus and CD4+ (T-helper) cells are located. Most of the HIV clinical studies in Minnesota are conducted under the auspices of the AIDS Clinical Trials Group (ACTG) or the AIDS Research Consortium of the Twin Cities (ARCTiC). Much expertise is available in Minnesota addressing a wide range of topics, from epidemiology, to basic virology, to prevention. To optimize patient access to clinical studies, we recommend that physicians discuss available clinical studies with an HIV investigator soon after first seeing a new HIV-infected patient.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Retirement of senior physicians in rural Minnesota. Factors influencing physicians' plans to retire.

The demand for physicians in rural Minnesota is likely to increase significantly over the next few years. Nearly 20% of all rural physicians in Minnesota are older than age 65. This paper reports the results of a survey of rural Minnesota physicians over age 60 on their current practices and their plans for retirement. Of the 33 physicians questioned, 25 (75%) currently had plans to retire and more than half of the 25 planned to retire in the next two years. Factors that these physicians perceived as important in determining their decisions to retire or continue practice are described, and implications for the delivery of health care in rural communities are discussed.

Aged↗
PubMed1995

Life after medical practice. A retirement profile of Minnesota physicians.

This study investigates the current dynamics of physician retirement in Minnesota. A survey of all retired Minnesota physicians (878, with 65.7% response rate) revealed that 73% retired in their 60s, 22% at age 65. Good health was reported by 69% of the respondents, and fair health by 26%. Income was sufficient in most cases; 64% of respondents reported living comfortably, and only 14% said their incomes are barely adequate. The study also showed that retired physicians consider nonmedical activities much more important than medical activities; heading the list were visiting family (86%), reading (79%), and travel (63%). Finally, 35% of respondents found retirement to be better than they had expected, 54% found it about as expected, and only 9% felt retirement was not as good as expected. In retirement, Minnesota physicians are generally healthy, have sufficient funds to live comfortably, and generally spend their time doing nonmedical activities.

Age Factors↗
PubMed1996

Suffocations in grain bins--Minnesota, 1992-1995.

Suffocation in flowing grain is the most common cause of death associated with grain storage structures in the United States: during 1985-1989, suffocation accounted for 49 grain- and silage-handling-associated fatalities. During 1992-1995, nine persons in Minnesota died in separate incidents from asphyxiation after becoming engulfed in flowing grain within a grain storage structure. The Minnesota Fatality Assessment and Control Evaluation program (FACE), a program sponsored by CDC's National Institute for Occupational Safety and Health (NIOSH), was notified of the incidents by the state Occupational Safety and Health Administration (MN-OSHA), Minnesota Extension Services, and a newspaper clipping service. This report describes the investigation of three of these incidents by FACE, summarizes surveillance for grain bin suffocations during 1992-1995, and provides recommendations to prevent suffocations associated with grain storage bins.

Accidents, Occupational↗
PubMedDate not supplied

Impact of the Mammography Quality Standards Act on access in Minnesota.

OBJECTIVES: The Minnesota Department of Health surveyed registered mammography facilities to assess their accreditation status prior to full implementation of the Federal Mammography Quality Standards Act (MQSA), which mandated accreditation of all mammography facilities by October 1994; to strategize on the steps that might be taken to avoid closure of facilities; and to evaluate the ultimate impact of the law on the availability of mammography in Minnesota. METHODS: Mammography facilities registered with the Radiation Control Section of the state health department were surveyed five months prior to and four months after the October 1994 deadline. Data collected included accreditation status, plans for continuing service, number of mammograms performed, and areas in which technical assistance was needed. In October 1995, the number and distribution of facilities were determined from the Radiation Control Section registration database. RESULTS: The pre-MQSA survey of 182 respondents found that 96% planned to continue mammography services but only 49% were accredited. The remaining 51% had applications in progress. In the post-MQSA survey, 70% of 182 facilities were found to be accredited, and 30% were operating under provisional certification. As of October 1995, although six facilities had closed, there was a net gain of four mammography facilities providing on-site service. CONCLUSIONS: Despite fears to the contrary, access to mammography in the state of Minnesota was not adversely affected by full implementation of the Mammography Quality Standards Act.

Accreditation↗
PubMed1997

Who is still uninsured in Minnesota? Lessons from state reform efforts.

OBJECTIVE: To describe Minnesota's health care system reform efforts and their implications for other state and national reform initiatives, document the rate of uninsurance in 1990 and 1995 with special attention to childrens' access to health insurance, and examine the effectiveness of MinnesotaCare, a voluntary state-subsidized health care plan, in serving its target population. DESIGN: Three cross-sectional telephone surveys: 2-stage random samples of Minnesotans of all ages in 1990 and 1995 and a stratified random sample of MinnesotaCare enrollees in 1994. PARTICIPANTS: For the 2 statewide surveys, 10310 respondents participated in 1990 and 11519 in 1995; more detailed information was collected on approximately 1600 respondents in each survey. Eight hundred MinnesotaCare enrollees participated in the third survey conducted in 1994. MAIN OUTCOME MEASURE: Changes in rates of uninsurance. RESULTS: While the rate of uninsurance increased at the national level, the point-in-time Minnesota rate remained stable and low at 6% between 1990 and 1995. The proportion of children uninsured for 12 months or more decreased from 5.2% in 1990 to 3.1% in 1995, while the proportion of uninsured single adults remained stable at approximately 11%. There was no evidence that MinnesotaCare enrollees are gaming the program, or that the program has resulted in significant erosion from the private market. CONCLUSIONS: MinnesotaCare has enabled the state to maintain a low rate of uninsurance and has reduced this rate among its primary target: children. The program has been less effective in enrolling single adults, although it may be too early to witness the effects of recent expansions targeting this group. Minnesota's experience suggests that other state and national reform efforts aimed at reducing uninsurance, particularly among children, are likely to be successful.

Adult↗
PubMed1998

Fatalities associated with large round hay bales--Minnesota, 1994-1996.

Agriculture has one of the highest occupational fatality rates of all U.S. industries. Since the mid-1970s, traditional small-bale balers have gradually been replaced by large-bale balers in the agriculture industry. Expanded use of these balers has resulted in worker exposure to new hazards not present during handling of traditional small bales; the larger size of the bales increases the potential for serious injury or death while workers handle them. During 1994-1996, seven persons in Minnesota died in separate incidents that involved large round hay bales (i.e., cylindrical bales approximately 5 feet in length with flat ends, diameters of approximately 6 feet, and weights ranging from 750 to 1500 lbs). The Minnesota Fatality Assessment and Control Evaluation program (MN FACE), a program sponsored by CDC's National Institute for Occupational Safety and Health (NIOSH), was notified of these incidents by the Minnesota Extension Service, a newspaper clipping service, and/or by death-certificate review. This report describes three incidents that were reported to MN FACE during 1994-1996, summarizes national surveillance for bale-associated deaths during 1980-1995, and provides recommendations to prevent fatalities associated with large bales.

Accidents, Occupational↗
PubMed1998

An epidemiologic summary of the AIDS/HIV epidemic in Minnesota.

A cumulative total of 3,202 AIDS cases and 2,355 non-AIDS cases of HIV infection have been diagnosed in Minnesota and reported to the Minnesota Department of Health since 1982. The number of AIDS cases and HIV infection cases diagnosed annually peaked five to 10 years ago. New treatments for HIV infection have led to a marked reduction in mortality. The number of deaths due to AIDS/HIV in 1997 (76) was the lowest number in Minnesota since 1986. Several trends continue to evolve in reported AIDS/HIV cases. First, the proportion of female cases has increased over time. Second, male-to-male sex remains the most common exposure category, but the proportion has declined over time. In contrast, the proportion of cases related to injecting drug use and heterosexual contact has increased over time. Third, an increasing proportion of AIDS/HIV patients are black. Although progress has been made in reducing AIDS/HIV incidence, more Minnesotans are living with AIDS/HIV than ever before.

Acquired Immunodeficiency Syndrome↗
PubMed1998

Managed care in rural Minnesota. Family physicians' attitudes and perceptions.

Prepaid managed care medicine has become dominant in urban Minnesota and is making its way into the rural setting. This study assesses the attitudes of rural family practice physicians in Minnesota toward managed care. A survey, consisting primarily of five-point Likert scale statements, was mailed to 798 rural Minnesota family practice physicians, with a response rate of 35% (281 respondents). We tabulated overall responses and made comparisons based on practice characteristics and years in practice. Twenty physicians participated in a follow-up telephone interview. We also conducted telephone interviews with 10 representatives from managed care organizations. Both positive and negative attitudes toward managed care emerged. Two-thirds of respondents did not feel that their time with patients was diminished under managed care. However, 67% of respondents felt that managed care organizations had failed to incorporate rural patients' specific needs into their policies. Only 7% of respondents felt that managed care organizations adequately explained their benefits packages to enrollees. Rural family practitioners' apparent disillusionment with current managed care models merits the attention of those concerned with medical care in rural areas.

Attitude of Health Personnel↗
PubMed1976

Effect of active and passive immunizations with lipid A and salmonella minnesota Re 595 on gram-negative infections in mice.

The capacity of lipid A, a structure common to the lipopolysaccharide cores of all gram-negative bacteria, to serve as an active immunizing agent in mice and to protect these animals against gram-negative infections was investigated. Active immunization experiments were also performed with the Re mutant of Salmonella minnesota 595 which carries a lipopolysaccharide composed of lipid A and three residues of ketodeoxyoctonic acid. Single injections of lipid A complexed to acid-hydrolyzed bacteria as carriers failed to induce specific protection against subsequent challenge infections with E. coli O4 and S. breslau. Repeated injections of lipid A resulted in good protection against intraperitoneal challenge with S. breslau and partial protection against intravenous challenge with the same organism but did not alter the sensitivity of mice to challenge infections with E. coli or Pasteurella multocida. Whole antisera or serum fractions from rabbits in which high titers against lipid A had been attained by repeated intravenous injections of the antigen did not protect mice against challenge infections with E. coli O4. In contrast a single injection of the Re mutant of S. minnesota antigen in combination with incomplete Freund's adjuvant provided substantial protection against an otherwise lethal intraperitoneal infection with S. breslau over a period of at least 45 days. Repeated application of the Re antigen resulted in partial protection against experimental infections with E. coli O4, S. breslau and Pasteurella multocida. Injections of S. minnesota Re 595 antiserum provided better protection against an E. coli O4 infection than lipid A sera or antibodies of the IgG or IgM type directed against this antigen.

Animals↗
PubMed2000

Impacts of rotational grazing and riparian buffers on physicochemical and biological characteristicsof southeastern Minnesota, USA, streams.

We assessed the relationship between riparian management and stream quality along five southeastern Minnesota streams in 1995 and 1996. Specifically, we examined the effect of rotationally and continuously grazed pastures and different types of riparian buffer strips on water chemistry, physical habitat, benthic macroinvertebrates, and fish as indicators of stream quality. We collected data at 17 sites under different combinations of grazing and riparian management, using a longitudinal design on three streams and a paired watershed design on two others. Continuous and rotational grazing were compared along one longitudinal study stream and at the paired watershed. Riparian buffer management, fenced trees (wood buffer), fenced grass, and unfenced rotationally grazed areas were the focus along the two remaining longitudinal streams. Principal components analysis (PCA) of water chemistry, physical habitat, and biotic data indicated a local management effect. The ordinations separated continuous grazing from sites with rotational grazing and sites with wood buffers from those with grass buffers or rotationally grazed areas. Fecal coliform and turbidity were consistently higher at continuously grazed than rotationally grazed sites. Percent fines in the streambed were significantly higher at sites with wood buffers than grass and rotationally grazed areas, and canopy cover was similar at sites with wood and grass buffers. Benthic macroinvertebrate metrics were significant but were not consistent across grazing and riparian buffer management types. Fish density and abundance were related to riparian buffer type, rather than grazing practices. Our study has potentially important implications for stream restoration programs in the midwestern United States. Our comparisons suggest further consideration and study of a combination of grass and wood riparian buffer strips as midwestern stream management options, rather than universally installing wood buffers in every instance. RID="" ID="" The Unit is jointly sponsored by the US Geological Survey, Biological Resources Division; the Minnesota Department of Natural Resources; the University of Minnesota; and the Wildlife Management Institute.

Journal Article↗
PubMed2006

The Irvine-Minnesota inventory to measure built environments: development.

BACKGROUND: Researchers and policymakers increasingly identify active living-including walking and bicycling for travel and recreation-as a potential strategy to increase rates of physical activity in the United States. Understanding the impact of the built environment on physical activity levels requires reliable methods to measure potentially relevant built environment features. This paper presents an audit tool-the Irvine Minnesota Inventory-that was designed to measure a wide range of built environment features that are potentially linked to active living, especially walking. METHODS: The inventory was created through a literature review, focus group interviews, a panel of experts, and field testing in 27 settings. The inventory was developed in 2003-2004. RESULTS: The Irvine Minnesota Inventory includes 162 items, organized into four domains: accessibility (62 items), pleasurability (56 items), perceived safety from traffic (31 items), and perceived safety from crime (15 items). (Some items are in multiple domains.) The inventory includes both a paper version and a version in Microsoft Access, to allow data to be input directly into the computer. CONCLUSIONS: Limitations of methods used to develop the inventory are discussed. Strategies are offered for using the Irvine Minnesota Inventory to systematically and reliably measure characteristics of the built environment that are potentially linked to active living.

Bicycling↗