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PubMed1995

Availability of rural Minnesota obstetric services: is it a problem?

In the late 1980s several published articles predicted a crisis in the availability of obstetric care due to declining numbers of rural obstetrical providers. Several state and national studies documented the adverse impact of malpractice and time demands on both urban and rural physicians. But only limited information is available to document current trends in rural obstetrical practice and assess whether or not the predicted crisis occurred. This study sought to provide that updated information for rural Minnesota. A telephone survey of all rural Minnesota obstetrical providers was used to document the number, location, and specialty of rural obstetrical providers, their practice limitations, and plans for future practice. This data was combined with state perinatal statistics for each county to further assess obstetrical care availability and perinatal outcomes. All rural Minnesota obstetricians and certified nurse midwives provide obstetrical care as did 69 percent of all rural family physicians. Only 27 percent of rural obstetrical providers put any type of restrictions on their obstetrical practices. During the past year, 67 currently practicing rural physicians have stopped providing obstetrical care while 55 new obstetrical providers have begun rural practice. Two to 3 percent of current rural providers plan to retire or discontinue obstetrical services during the next five years. The provider demographics from the survey identified eight counties with no prenatal providers, and 12 additional communities of decreased provider availability. However, only two of the counties with no prenatal providers and five of the counties with areas of limited providers had increased percentages of adverse prenatal outcomes such as low birthweight or late prenatal care. This study concluded that Minnesota does not have a serious statewide problem with availability of rural obstetrical providers. However, a few isolated regions of the state have limited provider availability, including limited availability of local high-risk services and consultants.

Catchment Area, Health↗

PubMed2002

The Minnesota Twin Registry: current status and future directions.

The Minnesota Twin Registry is a birth-record-based twin registry. Begun in 1983, it includes data for 4307 surviving intact pairs born in Minnesota between 1936 and 1955. In addition, the Registry includes 901 twin pairs born in Minnesota from 1904 to 1934, as well as 391 male pairs born in Minnesota from 1961 to 1964. The research focus is primarily on human individual differences assessed by self-report. Questionnaires completed by the participants include measures of personality, occupational interests, demographics, and leisure-time activities. We outline major contributions that have resulted from Registry research, as well as current and future research directions.

Birth Certificates↗

PubMed2001

Mycobacterium tuberculosis disease in Somali immigrants in Minnesota.

STUDY OBJECTIVE: To characterize pulmonary and extrapulmonary Mycobacterium tuberculosis cases in the Somali community in Minnesota. DESIGN: Retrospective chart review of active tuberculosis cases in Somalis reported to the Minnesota Department of Health between January 1993 and June 1998. PATIENTS: Ethnic Somalis in the state of Minnesota with M tuberculosis diagnosed by positive culture or radiographic findings consistent with tuberculosis and clinical improvement when treated with antituberculous drugs. RESULTS: Eighty-two Somali patients were diagnosed with tuberculosis during the study period. Extrapulmonary disease (typically lymphadenopathy) was present in 46% (n = 38). The 1997 incidence of tuberculosis in Minnesota's Somali population was estimated at 170 cases per 100,000 population compared with a national incidence of 20.5 per 100,000 among African Americans and 2.5 per 100,000 among whites. Ninety percent of Somali patients were < 40 years of age; 63% were diagnosed within 1 year of immigration, and > 90% had positive results with the purified protein derivative skin test. M tuberculosis was confirmed in 24 of 25 isolates from extrapulmonary cases. Multidrug resistance was present in 3.4%, and only two patients had AIDS. CONCLUSIONS: Somalis have a high incidence of active disease, with frequent extrapulmonary involvement in the absence of AIDS, clinical presentation shortly after immigration, and infrequent infection with resistant organisms. Health-care providers should maintain an increased awareness for tuberculosis when evaluating Somali immigrants.

Adult↗

PubMedDate not supplied

Maternal postpartum health care utilization and the effect of Minnesota early discharge legislation.

PURPOSE: To describe maternal postdischarge follow-up and health care utilization in the context of Minnesota's early discharge legislation, which mandates coverage for a home visit for a mother and baby who voluntarily leave the hospital early. METHODS: Claims data from a large managed care organization were used to identify 22,944 women giving birth from January 1995 through February 1999. Study variables included home or clinic visits within 1 week of discharge (early follow-up), readmissions within 1 month of discharge, and urgent care or emergency department visits within 2 months of discharge. RESULTS: After enactment of Minnesota's legislation, the percentage of mothers with short stays decreased from 52% to 16% for vaginal births and from 87% to 63% for cesarean births (P =.001). Overall, 33% of mothers with vaginal births and 40% with cesarean births had early home or clinic follow-up (P =.001). Mothers who stayed 0 or 1 hospital days after vaginal births were more likely to have early follow-up than those with longer stays (37% vs 32%, P =.01). However, mothers who stayed 2 or 3 days after cesarean birth were no more likely to have early follow-up than mothers who stayed 4 or more days (39% vs 42%, P =.08). Rates of early follow-up were significantly higher after enactment of Minnesota's legislation, regardless of length of stay. CONCLUSIONS: Implementation of Minnesota's early discharge legislation corresponded with significantly increased lengths of stay and an increase in the percentage of mothers who received early follow-up visits. However the majority of mothers with short stays continued to lack early follow-up.

Adolescent↗

PubMed1983

Surveillance for California encephalitis group virus illness in Wisconsin and Minnesota, 1978.

During the summer and fall of 1978, active surveillance for encephalitis in southwestern Wisconsin and southeastern Minnesota resulted in the detection of the largest number of cases of California encephalitis group (CEG) virus infections ever documented in that region, where CEG virus is known to be endemic. A total of 75 laboratory-confirmed and eight presumptive cases of CEG virus infections were identified as a result of serologic testing completed in the Wisconsin and Minnesota State Laboratories. Cases included 46 residents of Wisconsin, 25 of Minnesota, 10 residents of Iowa and two from Illinois. The outbreak peaked during the last half of August and the first half of September. Eighty percent of patients were less than 10 years of age; only one case was documented in an adult (greater than or equal to 18 years). The clinical picture in patients ranged from mild aseptic meningitis to encephalitis with coma; convulsions occurred in 31% (22/72) of patients. One patient, a 3-year-old girl, died. The high incidence of infection detected in this investigation may be representative of the endemic incidence of CEG illness in the region and suggests that CEG infections in children residing in endemic areas in Wisconsin and Minnesota may be a greater public health problem than previously recognized.

Adolescent↗

PubMed1989

Performance characteristics of serologic tests for human immunodeficiency virus type 1 (HIV-1) antibody among Minnesota blood donors. Public health and clinical implications.

STUDY OBJECTIVE: To evaluate performance characteristics of sequential enzyme immunoassay (EIA) and Western blot human immunodeficiency virus type 1 (HIV-1) antibody testing in a low-risk population. DESIGN: Three-year prospective study of a selected sample from a community-based population. SETTING: Two blood collection facilities in Minnesota. POPULATION: Minnesota blood donors. RESULTS: During the study period, 630,190 units of blood (donations) from an estimated 290,110 Minnesota-resident donors were screened for HIV-1 antibody. Seventeen Minnesota-resident donors were identified as positive for HIV-1 antibody. Sixteen donors were available for follow-up HIV-1 culture: all were culture positive. The other donor, who was not available for follow-up culture, was likely infected with HIV-1 based on a history of high-risk behavior and positive serologic findings for hepatitis B surface antigen. Using 95% binomial confidence intervals, performance characteristics for sequential EIA and Western blot HIV-1 antibody serology were as follows: false-positive rate by number of donations, 0% to 0.0006%; specificity by number of donations, 99.9994% to 100%; predictive value of a positive test, 81% to 100%. CONCLUSIONS: In this low-risk population, the false-positive rate of serologic tests for HIV-1 antibody, using HIV-1 culture as the definitive standard for infection status, was extremely low and test specificity was extremely high.

AIDS Serodiagnosis↗

PubMed1999

Childhood work-related agricultural fatalities--Minnesota, 1994-1997.

Agriculture is one of the most hazardous industries in the United States, with the second highest work-related fatality rate during 1992-1996 (21.9 deaths per 100,000 workers). During 1992-1995, 155 deaths were reported among agricultural workers aged < or =19 years; 64 (41%) of these youths were working in their family's business . In Minnesota during 1992-1996, agriculture had the highest fatality rate of any industry (21.3 per 100,000 workers). To characterize agriculture work-related deaths among youths in Minnesota during 1994-1997, the Minnesota Department of Health (MDH) analyzed data from the state's Fatality Assessment and Control Evaluation (FACE) program. This report presents five cases of agriculture work-related fatalities among youths in Minnesota.

Accidents, Occupational↗

PubMed2002

Minnesota childhood blood lead guidelines.

Lead poisoning continues to pose a major environmental health threat to Minnesota's children. Currently, about 2,000 children a year in Minnesota are identified as having elevated blood lead (greater than 10 micrograms/dL). The Minnesota Department of Health has developed statewide guidelines for screening, case management, and clinical treatment of children who have been exposed to lead. The screening guidelines target children with the highest risk of exposure. The case management guidelines provide information to public health agencies on recommended steps for dealing with an elevated blood lead case. The clinical treatment guidelines assist physicians and other health care professionals with the medical aspects of a lead case. These guidelines are based on state data, were developed using diverse work groups, and have been endorsed by the medical community. They provide Minnesota-specific guidance on how to best identify and treat a child exposed to lead and to minimize exposure.

Child↗

PubMed2005

Smoking rates among American Indian women giving birth in Minnesota. A call to action.

Maternal smoking is associated with a number of adverse effects including neonatal mortality, preterm delivery, low birth weight, decreased lung growth and function, and increased incidence of lower respiratory infections. This study looked at smoking trends among American Indian and white women in Minnesota who gave birth between 1999 and 2003. The authors used data from birth certificates issued by the state to determine the rate of smoking among both groups of women. They broke down the data further to look at and compare smoking rates of American Indian and white women based on where they gave birth (greater Minnesota or the Twin Cities metro area), when they began receiving prenatal care, their level of education, their age, the number of children they already had, and the weight of their baby. They found that 39% of American Indian women in Minnesota who gave birth during that period reported smoking, compared with 11% of white women. In addition, their findings showed that cigarette use among American Indian women in Minnesota who gave birth in 2003, was 36.5%--double the national rate of 18.3% forAmerican Indian women.

Adolescent↗

PubMed2006

Effect of rising medical student debt on residency specialty selection at the University of Minnesota.

The cost of a medical education continues to increase while the real value of physician compensation is decreasing. The University of Minnesota Medical School is the most expensive public medical school in the country. Rising tuition costs combined with a relative decrease in scholarship money is resulting in dramatic increases in medical student debt. The average debt load of a medical student graduating from the University of Minnesota was dollars 119,868 in 2004 and dollars 132,988 in 2005. Experts in medical education speculate that such heavy debt affects medical students' career choices. However, prior to this study, the relationship between student debt and residency specialty selection at the University of Minnesota had not been analyzed. This study found a significant correlation between debt and specialty selection at the University of Minnesota, Duluth campus, and no significant correlation at the Twin Cities campus in Minneapolis.

Career Choice↗

PubMed1990

Serodiagnosis of equine monocytic ehrlichiosis in selected groups of horses in Minnesota.

Antibody titer to Ehrlichia risticii was determined, in 2,549 equine serum samples, using an indirect fluorescent antibody assay. During 1986, samples were obtained from the Minnesota State-Federal Equine Infectious Anemia Diagnostic Laboratory, the Minnesota Racing Laboratory, from horses admitted to the University of Minnesota Veterinary Teaching Hospital, and as a result of field investigations of horses with acute diarrhea. Results of the study revealed antibody prevalence of 33, 24, 47, and 25% for the respective groups. There was no statistical association between seropositive status and age, sex, breed, or clinical problem of horses referred to the teaching hospital. There was an increase in the total percentage of seropositive samples over the duration of the sample collection period, suggesting a seasonal exposure pattern, and E risticii was associated with clinical and subclinical infections in horses of Minnesota.

Animals↗

PubMed1990

Access to hospital services in rural Minnesota.

A Minnesota Department of Health study on the financial condition of Minnesota's small, rural hospitals found that at least 12 hospitals were in precarious financial condition at the start of 1989, and many other hospitals were financially vulnerable. One-third or more of Minnesota's hospitals with fewer than 50 beds had negative net income in each year from 1984 to 1987. Using a standard of 30 minutes' maximum travel time for adequate access, the study revealed that about 19,000 Minnesotans in 14 counties currently have inadequate access to hospital services. Closing rural hospitals could leave additional Minnesotans without adequate access to hospital services. Given the financial condition of Minnesota's small, rural hospitals and the importance of maintaining access to hospital services in rural communities, the state may need to provide limited hospital subsidies to ensure access in geographically isolated areas.

Health Services Accessibility↗

PubMed1993

Fatalities attributed to entering manure waste pits--Minnesota, 1992.

In August 1992, four farm workers in Minnesota died in two separate incidents after entering manure waste pits: two were poisoned by hydrogen sulfide gas, and two were asphyxiated. The Minnesota Fatality Assessment and Control Evaluation (FACE) program was notified of the incidents by the state Occupational Safety and Health Administration and the Minnesota Farming Health Project, respectively. This report summarizes the investigations of these two incidents by the Minnesota FACE program and CDC's National Institute for Occupational Safety and Health (NIOSH) FACE personnel.

Accidents, Occupational↗

PubMedDate not supplied

Reported treatment of hypercholesterolemia by family physicians in Sweden and Minnesota.

Swedish guidelines on treatment of hyperlipidemia recommend higher cut-off levels for initiating treatment than do American guidelines, but are virtually identical for instituting and performing therapy. The aim of this study was to compare family physicians' reported practices in Sweden and Minnesota. We selected random samples of family physicians in southern Sweden and Minnesota for telephone interviews. Participation rates were 236/264 (89%) and 183/209 (88%), respectively. Swedish and Minnesota physicians adhered to their guidelines on cut-off levels in a case describing a 48-year-old man but, contrary to guidelines, reported higher cut-off levels for a 65-year-old man and a 65-year-old woman. In all cases described, Swedish physicians reported significantly higher cut-off levels. Swedish physicians were less prone to institute medication in older patients and less familiar with drugs. Minnesota physicians were more inclined to advise nicotinic acid derivatives (P < .0001 for all patient categories). Swedish physicians more frequently preferred resins (P = .00029) or fibrates (P = .0028) for the 48-year-old man and resins for the 65-year-old man (P = .0026). Despite common medical knowledge, the two medical communities are directed by different guidelines. Although adherence to cut-off levels was equally high in both groups, the use of lipid-lowering drugs has not become a familiar part of the therapeutic armamentarium for Swedish family physicians.

Aged↗

PubMed1998

Childhood cancer incidence and trends in Minnesota, 1988-1994.

Childhood cancer incidence patterns for Minnesota, obtained from the Minnesota Cancer Surveillance System, were compared with national rates as well as with historic data from eight Minnesota counties. In total, 1,140 neoplasms were diagnosed in children (ages 0 to 14) between 1988 and 1994. Leukemias were the most common diagnosis for boys (30.3%) and girls (29.6%), followed by central nervous system tumors. The average annual age-adjusted incidence rates for all cancer sites were 167.2 and 136.2 per million for boys and girls, respectively. These rates were somewhat higher than national rates. In particular, the incidence rate for astrocytoma in boys was significantly elevated. Childhood cancer incidence, particularly brain tumors, has increased in the eight-county region from 1969 to 1994. This analysis demonstrated the Minnesota's childhood cancer incidence patterns are similar to national patterns.

Adolescent↗

PubMed2000

The ability of a computer program based on the Marquette Matrix-12 short measurement matrix to replicate coding by the Minnesota ECG coding laboratory.

The study was undertaken to determine whether a computer program that uses "short measurement matrix" data from the Marquette Matrix-12 system can replicate Minnesota electrocardiogram (ECG) coding laboratory interpretations. An agreement was found between coding of median complex ECGs at the Minnesota ECG coding laboratory and coding based on Marquette Matrix-12 short measurement matrix. The comparison was based on 763 ECGs plus chest pain history and serum enzyme values for a stratified random sample of 141 patients hospitalized in 1990 or 1991 for an event coded as HICDA 410.x (acute myocardial infarction), 411 (other acute and subacute forms of ischemic heart disease), 413 (angina pectoris), or 796.9 (other ill defined and unknown causes of morbidity and mortality). The population was reconstructed from the stratified random sample to enable population-based inferences. Exact agreement between Matrix-12 and Minnesota coding laboratory interpretation on 4 ECG patterns (evolving diagnostic, diagnostic, equivocal, or other ECG pattern) was 74.5% (Kappa = 0.63 +/- 0.05) for the stratified random sample and 78.8% (Kappa = 0.66 +/- 0.05) for the reconstructed population. For coding myocardial infarction based on the ECG, serum enzyme levels, and ischemic chest pain, agreement was 91.5% (Kappa = 0.85 +/- 0.04) for the stratified random sample and 90% (Kappa = 0.83 +/- 0.04) for the reconstructed population. Although ECG interpretation by a computer program based on the short measurement matrix of the Matrix 12 system results in better agreement than prior attempts to replicate the Minnesota coding laboratory, interpretation remains unacceptably discordant.

Angina Pectoris↗

PubMed1982

Studies on the mechanism of bacterial resistance to complement-mediated killing. I. Terminal complement components are deposited and released from Salmonella minnesota S218 without causing bacterial death.

The mechanism of resistance of gram-negative bacteria to killing by complement was investigated. Complement consumption and uptake of purified, radiolabeled complement components on bacteria was studied using a serum- sensitive and a serum-resistant strain of Salmonella minnesota. Twice as many molecules of (125)I C3 were bound per colony-forming unit (CFU) of the smooth, serum-resistant S. minnesota S218 as were bound per CFU of the rough, serum-sensitive S. minnesota Re595 in 10 percent pooled normal human serum (PNHS), although 75-80 percent of C3 was consumed by both organisms. Hemolytic titrations documented total consumption of C9 by 5 min and more than 95 percent consumption of C5 and C7 by 15 min in the reaction with S218 with 10 percent PNHS. In contrast, negligible C5 depletion, 10 percent C7 consumption, and only a 26 percent decrease in C9 titer occurred with the serum-sensitive Re595. Binding of (125)I C5, (125)I C7, and (125)I C9 to S218 and Re595 was measured in 10 percent PNHS. A total of 6,600 molecules C5/CFU, 5,200 molecules C7/CFU, and 3,100 molecules C9/CFU bound to S218 after 5-10 min of incubation at 37 degrees C, but 50-70 percent of the C5, C7, and C9 bound to S218 was released from the organism during incubation at 37 degrees C for 60 min. Binding of 2,000 molecules C5/CFU, 1,900 molecules C7/CFU, and 9,000 molecules C9/CFU to Re595 was achieved by 20 min and was stable. The ratio of bound C9 molecules to bound C7 molecules, measured using (131)I C9 and (125)I C7, was constant for both organisms after 15 min and was 4.3:1 on Re595 and 0.65:1 on S218 in 10 percent PNHS. With addition of increasing amounts of purified, unlabeled (29 to 10 percent PNHS, there was no change in the C9:C7 ratio on Re595. However, with S218 there was a linear increase of the C9:C7 ratio, which approached the ratio on Re595. There was no (14)C release from S218 incubated in PNHS, nor was there evidence by electron microscopy of outer membrane damage to S218. Therefore, S. minnesota S218 is resistant to killing by PNHS, despite the fact that the organism consumes terminal complement components efficiently and that terminal components are deposited on the surface in significant amounts. The C5b-9 complex is released from the surface of S218 without causing lethal outer membrane damage.

Adsorption↗

PubMed1990

Protective effects of polyclonal sera and of monoclonal antibodies active to Salmonella minnesota Re595 lipopolysaccharide during experimental endotoxemia.

Mice were passively immunized with sera from blood donors active for rough lipopolysaccharides (LPS), the J5 (Rc chemotype) mutant of Escherichia coli O111:B4, and the Re595 (Re chemotype) mutant of Salmonella minnesota. All protected the mice against lethal challenge with smooth E. coli WF96 LPS, E. coli and Salmonella rough mutant LPS, or free lipid A. Epitopes recognized by monoclonal antibodies (MAbs) reacting with the LPS of S. minnesota Re595 or lipid A were localized in the 2-keto-3-deoxy-D-manno-octulosonic acid (KDO) region and on lipid A. Core-reactive MAbs reacted with their homologous Re LPS and with free lipid A. One, GL11, cross-reacted with the KDO alone. MAbs GL6, GL11, L.4, L.6, and L.8 protected the actinomycin D-sensitized mice against the lethal effects of LPS from E. coli WF96, Salmonella enteritidis, E. coli J5, S. minnesota Re595, and free lipid A. The GL11 antibody was also protective when injected after LPS challenge. These results indicate that antibodies directed against the core glycolipid of S. minnesota Re595 LPS may be useful as an additive form of therapy that may enable decreased mortality during gram-negative bacterial sepsis.

Animals↗