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PubMed2006

Market dynamics of community pharmacies in Minnesota.

BACKGROUND: From a pharmacist workforce perspective, an understanding of pharmacy location is important for monitoring access points for pharmacist services such as medication dispensing, medication counseling, medication therapy management, and disease management. OBJECTIVE: To understand access to community pharmacies, our goal was to describe changes in pharmacy mix (independent vs chain) between 1992 and 2002 for 87 counties in Minnesota. Study objectives were to describe the association of (1) change in population density, (2) metropolitan designation, change in (3) proportion of nonwhite population, (4) proportion of elderly population, and (5) household income with change in (a) number of community pharmacies overall, (b) number of chain pharmacies, (c) number of independent pharmacies, and (d) the independent-to-total community pharmacy ratio. METHODS: Records from the State of Minnesota Board of Pharmacy were used to examine changes in the community pharmacy mix from 1992 to 2002. Data on county level demographics in 1990 and 2000 were obtained from the US Census Bureau and Datanet. Chi-square analysis was used to test the relationships between the independent and dependent variables. RESULTS: As of 2002, every county in Minnesota had at least one pharmacy as was the case in 1992. The ratio of independent to chain pharmacies changed from approximately 2:1 in 1992 to approximately 1:1 in 2002. Chi-square results revealed that change in population density was significantly associated with change in the number of community pharmacies overall (P<0.001) and with change in chain pharmacies (P=0.03). The findings revealed an interesting u-shaped pattern for the association between population density and change in independent pharmacies. CONCLUSIONS: It appears that chain pharmacies follow changes in population density for making decisions about market entry and exit. The results suggest that some independent pharmacies might be closing due to chain competition in high population density growth areas. However, there was also evidence to suggest that population density decline may be an important determinant of independent pharmacy closures. In such environments, chain pharmacies are not likely to open new pharmacies to replace the independent pharmacy. Such a market dynamic may lead to access problems for citizens of these counties in the future.

Health Care Sector↗
PubMed2005

The Minnesota Molecular and Cellular Therapeutics Facility: a state-of-the-art biotherapeutics engineering laboratory.

Molecular-, gene-, cellular-, and tissue-based therapies have become increasingly acceptable modes of clinical therapy. Regulatory requirements and oversight have increased, and the need for facilities suited for production of such therapies has become more apparent. The Minnesota Molecular and Cellular Therapeutics Facility is a state-of-the-art laboratory at the University of Minnesota, Saint Paul, Minn, that was designed to support production of biologic products for use in clinical trials. A talented staff experienced in the medical, scientific, technical, and regulatory aspects of the development, production, and administration of such products complements the special design and construction of the facility. Hematopoietic stem cells (HSCs) are manipulated for transplant, and current clinical trials involving novel therapies include the use of allogeneic natural killer (NK) cells and tumor vaccines for the treatment of various malignancies and suicide gene-transduced T cells for the prevention of graft-vs-host disease (GVHD) after bone marrow transplantation. Other therapies, including marrow-derived multipotent adult progenitor cells (MAPCs), umbilical cord blood (UCB) stem cells, regulatory T cells, skeletal myoblasts, and monoclonal antibodies, will be used to treat a spectrum of disease and are in various phases of development. Here we provide an overview of the Minnesota Molecular and Cellular Therapeutics (MMCT) Facility, detailing our approach to the manufacture of novel therapeutics and highlighting current and future activities.

Academic Medical Centers↗
PubMed1990

The Minnesota Clinical Comparison and Assessment Project.

Efforts to quantify and improve the effectiveness and efficiency of health care services are critical to the health care system in the United States. Essential components of these efforts are clinician involvement and support and reliable clinical information systems. Organized medicine and the hospital industry in Minnesota have initiated and funded the Minnesota Clinical Comparison and Assessment Project (MCCAP) to begin to document, compare, and improve health care services. Through MCCAP, a forum, comprising leaders in the Minnesota health care community, oversees efforts to collaboratively identify and address quality of care. In addition, MCCAP will adapt guidelines for specific conditions/procedures, collect hospital-level data on clinical practices in the state relative to those conditions/procedures, and provide feedback so that physicians can evaluate their practice and modify it, if necessary, to improve quality of care.

Clinical Competence↗
PubMed1998

Congenital esotropia in Olmsted County, Minnesota.

OBJECTIVE: To determine the birth prevalence of and risk factors associated with congenital esotropia. DESIGN: Population-based prevalence study with nested case-control study. PARTICIPANTS: All residents of Olmsted County, Minnesota who were diagnosed with congenital esotropia and born between January 1, 1980 and December 31, 1989 (n = 47). Control subjects were chosen by selecting the next two sequential births to parents residing in Olmsted County, Minnesota (n = 94). METHODS: Cases were identified through the Medical Diagnostic Index of Mayo and the Rochester Epidemiology Project. The community medical records were reviewed to confirm case status and ascertain risk factor information. MAIN OUTCOME MEASURE: Birth prevalence of congenital esotropia. RESULTS: Forty-seven cases were identified from 17,536 live births, for a birth prevalence of 27 per 10,000 (95% confidence interval [CI], 20-35). Congenital esotropia was associated with prematurity (odds ratio [OR], 11.5; 95% CI, 3.4-39.2), a birth weight less than 2500 grams (OR, 4.6; 95% CI, 1.7-12.9), a low Apgar score at 1 minute (OR, 4.3; 95% CI, 1.7-11.2) and at 5 minutes (OR, 6.3; 95% CI, 1.3-30.7), and a family history of strabismus (OR, 3.5; 95% CI, 1.5-8.3). CONCLUSIONS: The birth prevalence of congenital esotropia in Olmsted County, Minnesota is lower than previous estimates. Prematurity, low birth weight, low Apgar scores, and a family history of strabismus are significant risk factors for congenital esotropia.

Apgar Score↗
PubMed2003

Photochemical characterization of water samples from Minnesota and Vermont sites with malformed frogs: potential influence of photosensitization by singlet molecular oxygen (1O(2)) and free radicals on aquatic toxicity.

Environmental pollutants activated by UV sunlight may have contributed to the recent decline in frog populations and the concomitant increase in malformations in the USA and abroad. UV radiation is able to mutate DNA and to initiate photosensitization processes that generate mutagenic and biologically disruptive oxygen transients. We have examined water from selected sites in Minnesota and Vermont using singlet molecular oxygen (1O(2)), detected by its phosphorescence and free radicals detected by spin trapping, as markers for photosensitization. Water from a pond in Minnesota with malformed frogs, which also causes malformations in the laboratory, photosensitized more 1O(2), even though it absorbed less UV light compared to water from a site that did not cause malformations. This suggested that unknown natural or pollutant agents were present, and that photosensitization may be involved. Although UV irradiation of the two Minnesota water samples in the presence of the spin trap 5,5-dimethyl-1-pyrroline N-oxide (DMPO) revealed the presence of the DMPO/*OH, DMPO/*H(e(aq)-) and DMPO/*C(unknown) adducts there were no qualitative or quantitative differences between them. We also examined water samples from several sites in Vermont, and compared them by measuring the quantum yield of 1O(2) photosensitization. While all the Vermont samples produced a small amount of 1O(2), there was no clear correlation with the incidence of frog malformations. However, the samples differed strongly in absorption spectra and the ability to quench 1O(2). These factors may determine how much UV light is absorbed and converted into chemical reactions. Our results show that photochemical characterization of 1O(2) photosensitization is possible in untreated natural water samples. Photosensitization falls into the category of global factors that may be closely associated with the effects of UV irradiation of the Earth's environments. Thus, photosensitization might be an important component in global amphibian malformation and decline. The observation of 1O(2) emission directly from natural water may also provide new opportunities to investigate the involvement of 1O(2) in other complex environmental processes.

Animals↗
PubMed2001

A comparison of gambling by Minnesota public school students in 1992, 1995, and 1998.

The purpose of this study was to compare rates of gambling among Minnesota public school students between 1992, 1995, and 1998. The three samples included 75,806 students in the 9th and 12th grades in 1992; 73,897 9th and 12th grade students in 1995; and 78,564 9th and 12th grade students in 1998. Students were administered the Minnesota Student Survey, a 121-item, anonymous, self-administered, paper-and-pencil questionnaire that inquires about multiple behavioral domains, including gambling behaviors. The same questionnaire, with minor revisions to the gambling items, was administered in 1992, 1995, and 1998 to students in their classrooms by the Minnesota Department of Education. The results showed two opposite trends. On the one hand, fewer students gambled in 1998 than in 1995 and 1992. On the other hand, there was a small, but growing number of 12th grade students who gambled frequently. In terms of trends over time for specific games, the lottery showed a significant decline in the number of 9th grade students who played at all. There was also a significant increase in the number of 12th grade students who played the lottery weekly or more often. The findings that frequent lottery gambling has increased among 12th grade students and that underage gambling continues among these students, are both cause for concern. This is the first generation of youth to be exposed to widespread accessability to legalized gambling venues and gambling advertising. Legalized gambling may be a new "rite of passage" for some of today's youth. It will be important to continue to monitor youth gambling and to provide information and resources to assist youth in making healthy decisions about their gambling behavior.

Adolescent↗
PubMed1999

Adherence to the ten steps of the Baby-Friendly Hospital Initiative in Minnesota hospitals.

BACKGROUND: A worldwide campaign has been initiated to improve the in-hospital care of mothers and babies through increased breastfeeding. The four objectives of the current investigation were to determine the in-hospital breastfeeding rate for Minnesota hospitals, to analyze the relationship between the in-hospital breastfeeding rates and selected hospital demographic characteristics, to determine the rate of adherence to each of the Baby-Friendly Hospital Initiative (BFHI) Ten Steps, and to analyze the relationship between the adherence rates for each of the Ten Steps and selected demographic characteristics. METHODS: A descriptive survey was conducted and analyzed for the year of 1994 from 79 (83%) Minnesota hospitals. Respondents were directors of nursing, nursing managers, or other staff familiar with their hospital's breastfeeding policies and practices. RESULTS: The average breastfeeding initiation rate was 59 percent. Four of the Ten Steps were implemented with a low adherence rate (0-49%), five were implemented with a moderate rate (50-89%), and none was implemented with a high rate (90-100%). Breastfeeding initiation rates and adherence to the Ten Steps varied with the size of the city and the number of births per year. CONCLUSIONS: Improvements in breastfeeding policies, practices, and staff education are needed if Minnesota hospitals are to provide care consistent with the Ten Steps of the BFHI. The results provide baseline information to guide institutional change that could promote successful breastfeeding experiences for postpartum families. This survey instrument could be used easily by researchers in other sites to assess nine of the Ten Steps.

Breast Feeding↗
PubMed2005

Asthma among rural Minnesota adolescents.

This study examined the prevalence of and risk factors for wheezing and asthma in rural Minnesota adolescents. A survey querying about wheezing, asthma, farm residence, and other respiratory-related factors was administered to all 9th to 11th grade students (N = 13,490) in a stratified, random sample of high schools in rural Minnesota. Nearly one in 8 (12.6%) students reported ever-diagnosed asthma, and 9.2% reported current asthma. Students living on farms reported less wheezing and asthma than rural non-farm students. Obesity and smoking were associated with wheezing and asthma in all rural adolescents. Asthma rates increased with age among girls and may be largely accounted for by simultaneous increases in smoking rates. Despite the apparent protective effect of farm residence, asthma remains a significant public health issue among rural Minnesota adolescents.

Adolescent↗
PubMed1995

The Minnesota Cancer Pain Project: design, methods, and education strategies.

The Minnesota Cancer Pain Project (MCPP) is a community-based research project to test various innovative education strategies for improving cancer pain management (CPM) in Minnesota. The main hypothesis is that community-based, multidisciplinary and integrated education programs can improve CPM and change knowledge, attitudes, and behaviors regarding CPM in cancer patients, their families, and community physicians and nurses. The specific aim of the MCPP is to demonstrate effective methods to improve CPM in communities. The MCPP design is a randomized trial with before- and after-intervention assessments of cancer pain and CPM knowledge, attitudes, and behaviors among cancer patients and their families, physicians, and nurses. The unit of randomization and study is the community, with six Minnesota communities participating in the MCPP. This paper describes the hypotheses, design, methods, and education strategies of the MCPP. Baseline data from the participating communities and the cancer patient sample are reported.

Family↗
PubMed2001

Epidemiology and clonality of community-acquired methicillin-resistant Staphylococcus aureus in Minnesota, 1996-1998.

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged among patients in the general population who do not have established risk factors for MRSA. Records from 10 Minnesota health facilities were reviewed to identify cases of MRSA infection that occurred during 1996-1998 and to identify which cases were community acquired. Susceptibility testing and pulsed-field gel electrophoresis (PFGE) subtyping were performed on available isolates. A total of 354 patients (median age, 16 years) with community-acquired MRSA (CAMRSA) infection were identified. Most case patients (299 [84%]) had skin infections, and 103 (29%) were hospitalized. More than 90% of isolates were susceptible to all antimicrobial agents tested, with the exception of beta-lactams and erythromycin. Of 334 patients treated with antimicrobial agents, 282 (84%) initially were treated with agents to which their isolates were nonsusceptible. Of 174 Minnesota isolates tested, 150 (86%) belonged to 1 PFGE clonal group. CAMRSA infections were identified throughout Minnesota; although most isolates were genetically related and susceptible to multiple antimicrobials, they were generally nonsusceptible to initial empirical therapy.

Adolescent↗
PubMed2005

HIV-1 subtype diversity in Minnesota.

BACKGROUND: Genetic variation in human immunodeficiency virus (HIV)-1 poses significant public-health and clinical challenges. In North America, subtype B is most prevalent. HIV-1 subtyping is not integrated into routine HIV/acquired immunodeficiency syndrome surveillance in the United States. In 2003, the Minnesota Department of Health piloted HIV-1 subtyping with routine surveillance to describe the existence and variety of non-subtype B strains. METHODS: Targeted HIV-1 subtype surveillance was conducted on 98 African-born HIV-infected patients. Sentinel subtype surveillance was conducted in a Minneapolis sexually transmitted disease clinic on 28 newly diagnosed non-African HIV-positive patients. Subtype determination was based on a partial sequence of the gp41 region of the HIV-1 env gene. RESULTS: Subtyping was successful for 87 of 98 samples from African-born HIV-infected patients; 95% were non-B subtypes. The 7 subtypes observed were consistent with strains endemic in patients' birth regions. Subtyping was also completed for samples from 25 of 28 non-African-born patients; all were subtype B. CONCLUSIONS: Multiple HIV-1 subtypes are present in Minnesota. Our data suggest that most of the HIV cases in Minnesota among African-born patients are non-B subtypes. Population-based surveillance inclusive of groups at high risk for variant strains is needed to monitor the prevalence and variety of HIV subtypes in the United States.

Adult↗
PubMed2005

Minimally invasive therapy for benign prostatic hyperplasia: practice patterns in Minnesota.

BACKGROUND AND PURPOSE: Benign prostatic hyperplasia (BPH) affects more than 50% of men by the age of 60 and 90% by age 85. Many of these men are not candidates for surgical procedures such as transurethral resection of the prostate (TURP), stimulating the development of less-invasive forms of therapy. We studied the utilization of these newer therapies by urologists practicing in Minnesota. MATERIALS AND METHODS: An anonymous questionnaire was sent to 174 members of the Minnesota Urological Society, of which 58 were available for analysis. A case scenario was presented of a patient with BPH refractory to medical therapy. The options were traditional and minimally invasive therapies. The physician was asked to select whether he or she would offer each option and perform the procedure or refer the patient within or outside the practice. Statistical analysis was performed using chi-square and two-sample t-tests on Minitab software. The results were considered significant at P < 0.05. RESULTS: While 59% of the respondents would offer both minimally invasive and traditional alternatives, 10% would offer only minimally invasive therapy, while 29% would offer only traditional therapy (P = 0.01). The most common minimally invasive therapies offered were transurethral microwave thermotherapy and (55%) and transurethral needle ablation (33%). If they offered a form of minimally invasive therapy, the majority of respondents would perform the procedure themselves. Rural urologists were less likely to offer minimally invasive therapy (43%) than metro physicians (81%; P = 0.035). There was no significant difference in the use of minimally invasive therapies by rural and urban urologists (P = 0.409) or urban and metropolitan urologists (P = 0.119). Urologists completing their training between 1960 and 1980 were less likely to offer minimally invasive therapy. There was no significant difference in the likelihood of offering traditional versus minimally invasive alternatives according to the percent of managed care in the practice. CONCLUSIONS: Urologists closer to the completion of their residency training are more likely to include a minimally invasive technique in their treatment plan, while urologists practicing in rural Minnesota are less likely to offer minimally invasive procedures. Further emphasis should be placed on increasing the availability of minimally invasive techniques in rural settings.

Age Factors↗
PubMedDate not supplied

Contemporary management of ureteropelvic junction obstruction: practice patterns in Minnesota.

BACKGROUND AND PURPOSE: Ureteropelvic junction (UPJ) obstruction can be addressed surgically by an open, laparoscopic, endoscopic, or fluoroscopic procedure. Our objective was to establish what surgical alternatives are currently offered by urologists in Minnesota. MATERIALS AND METHODS: A questionnaire was sent to 174 members of the Minnesota Urological Society. Practice settings were characterized as rural, urban, or metropolitan on the basis of the ZIP-code classifications of the Minnesota Ambulance Association and state geographic legislation. Respondents were asked to select initial treatment options for an adult patient with flank pain, decreased renal function, and hydronephrosis secondary to UPJ obstruction. RESULTS: Whereas 60% of the respondents would offer open pyeloplasty, only 12% would offer it as the only treatment option. The two most common minimally invasive therapies offered were the Acucise balloon (48%) and percutaneous antegrade endopyelotomy (48%). Rural urologists were more likely to offer Acucise balloon incision (71%) than were urban (28%; P=0.045) or metropolitan (55%; P=0.412) urologists. CONCLUSIONS: The majority of urologists still offer open pyeloplasty as first-line therapy for UPJ obstruction. Further emphasis should be placed on increasing the availability of endoscopic and laparoscopic procedures.

Adult↗
PubMed2005

Eliminating diagnostic drift in the validation of acute in-hospital myocardial infarction--implication for documenting trends across 25 years: the Minnesota Heart Survey.

Long-term trends in epidemiologic studies of acute myocardial infarction (AMI) require application of a consistent diagnostic algorithm. Typically an algorithm includes chest pain, cardiac enzymes, electrocardiographic findings, and autopsy results. The Minnesota Heart Survey (MHS) has determined trends for incident AMI and for in-hospital and long-term outcomes over a 25-year period (1970-1995). However, dramatic changes have occurred that seriously challenge the ability of the MHS and other epidemiologic studies to use a consistent diagnostic algorithm. These include newer and more sensitive cardiac biomarkers, introduction of diagnosis-related groups, and change in International Classification of Diseases coding. In the MHS, the electrocardiogram is the only diagnostic element consistently available and consistently classified over this 25-year period. The authors identified eight dichotomous Minnesota Code criteria that provided a consistent diagnostic method from 1970 to 1995 as documented by extensive cross-validation. These criteria were combined into a logistic score and used to define incident, recurrent, and attack AMI rates over this 25-year period. For both men and women, AMI rates determined by electrocardiogram are parallel to rates based on the International Classification of Diseases and parallel over adjacent survey periods to the standard MHS algorithm. The electrocardiogram classified by Minnesota Code provides the only consistent long-term diagnostic tool for AMI trends over this 25-year period.

Adult↗
PubMed2004

Resorptive drug use among community-dwelling women in Minnesota.

PURPOSE: The frequency of and factors associated with the use of resorptive medications among community-dwelling women age 45 years or older in Minnesota were studied. METHODS: The study was a secondary analysis of a cross-sectional survey mailed to 1700 community-dwelling women age 45 years or older in Minnesota. The survey was designed to collect information about women's attitudes and beliefs regarding osteoporosis and antiresorptive medications. Respondents were also asked to give a detailed list of all prescription medications they currently used, including the quantity and directions for use. Descriptive statistics were calculated for the demographic, health, and medication-use characteristics of all respondents and for the subset of those using resorptive medications. Chi-square analysis and logistic regression were used to test bivariate and multivariate relationships. RESULTS: Of the 990 usable surveys returned (adjusted response rate of 61.1%), 84 respondents (8.5%) reported using a resorptive drug. Age, health status, and the use of health care services (monthly physician visits and prescription use) were associated with resorptive drug use, controlling for other variables in the model. Women using resorptive medications were nearly 2.5 times more likely to report osteoporosis and osteopenia than women not using these medications. CONCLUSION: The use of resorptive medications in community-dwelling women in Minnesota was highest among those 75-84 years of age, women who were in poor health, and those frequently using health care services. These women were more likely to report using newer antiresorptive medications but were not more likely to use hormone therapy or calcium supplementation.

Aged↗
PubMed1986

Analysis of community-based cardiovascular disease prevention studies--evaluation issues in the North Karelia Project and the Minnesota Heart Health Program.

Karelia project of the Minnesota Heart Health Program. International Journal of Epidemiology 1986, 15: 176-182. Community-based cardiovascular disease control studies represent an effort to change cardiovascular disease rates in entire communities. Communities, rather than individuals, are the primary units of analysis. The cross-community multiple time series model to estimate and test the effects is based on multiple communities that are evaluated at several points over time. Issues that influence the power of the analysis include: the number of communities to be studied, community size and composition, sample sizes of surveys, the decision to use cohorts or cross-sectional surveys, the number of surveys conducted in each community, and assumptions of latencies in the effects. These points are illustrated using the experiences of the North Karelia Project and the Minnesota Heart Health Program. The North Karelia Project was a community-based cardiovascular disease (CVD) prevention programme consisting of a five-year intervention period in 1972-7. It took place in two provinces in Finland. The Minnesota Heart Health Program is similar, taking place between 1980 and 1990 in six communities in the American Midwest.

Cardiovascular Diseases↗
PubMed2006

Defining child exposure to domestic violence as neglect: Minnesota's difficult experience.

Policymakers are increasingly focusing on children exposed to domestic violence. The 1999 Minnesota legislature amended the definition of child neglect to include a child's exposure to family violence. What was initially seen as a simple change to bring more attention to children exposed to domestic violence resulted in great turmoil across Minnesota's county-run child protection system. Referrals to county child protection agencies expanded rapidly in the months following the law change, and no new state funding was provided to implement the legislation. A coalition of child welfare administrators and battered women's advocates successfully lobbied for the repeal of this change in definition. Many were dissatisfied with both the impact of the legislation and the fact that exposed children and their families were left without badly needed services. This article reconstructs how Minnesota's legislature made this change, its consequences, and the lessons that may be drawn from this experience.

Child↗
PubMed2004

Rural interprofessional service-learning: the Minnesota experience.

The Minnesota Rural Health School (MRHS), which operated from 1996 to 2003, was the University of Minnesota's first initiative that provided rural, community-based, interdisciplinary health professions education. The newly funded Minnesota Area Health Education Center (AHEC) is now coordinating interprofessional rural clinical education at the Academic Health Center level for the university. The service-learning curricular component is one of the most lasting legacies of the MRHS. This article provides a descriptive summary of the initial 61 service-learning projects completed by students from various health professions who participated in the MRHS and indicates the type of projects that have continuing effects. The seven community site coordinators affiliated with the MRHS completed a survey analyzing service-learning projects performed in their communities. Student interest was predominant in selecting 28% of the 61 projects, community interest was paramount in selecting 10%, and a mixture of both student and community interest contributed to 62% of project selection. Thirty of the projects were designed as single interventions, and the remaining 31 projects have ongoing impact. Students demonstrated interprofessional group synergy and significant creativity in addressing multiple community health care issues and needs, within time constraints of only ten to 12 days in which to develop and implement a service-learning project. Two project examples are described in detail to illustrate the challenges and successes of this type of civic engagement.

Academic Medical Centers↗