Minnesota Children Research Articles

35 Implementation of a quality improvement initiative to reduce pain and anxiety associated with needle-related procedures in a Canadian paediatric emergency department

Abstract Primary Subject area Emergency Medicine - Paediatric Background Needle-related procedures such as intravenous (IV) insertion, venipuncture, and lumbar puncture (LP) are commonly performed in children, particularly in the emergency department (ED). Children consistently rate these needle-related procedures as very distressing. While topical anesthetics have been shown to be highly effective and are available, they are inconsistently used. The Children’s Comfort Promise was originally developed at the Minnesota Children’s Hospital. It requires nursing staff to use four strategies for children undergoing needle-related procedures: (1) topical anesthetic, (2) sucrose or breastfeeding if ≤ 12 months, (3) Comfort positioning (swaddling, skin-to-skin, or facilitated tucking if ≤ 12 months and sitting upright for children > 12 months), and (4) age-appropriate distraction. Objectives We sought to evaluate compliance with all 4 Comfort Promise strategies for managing children’s pain and anxiety during needle-related procedures in a Canadian paediatric ED. Design/Methods Implementation of The Comfort Promise in March 2020 included a focus group to perform a root cause analysis, designation of nurse champions, monthly steering committee and ED working group meetings, and didactic education sessions. Our institution’s decision support unit identified all encounters of children 0-17 years who underwent at least one needle-related procedure at our paediatric ED from January 1 to November 30, 2020. The outcome was compliance with all 4 Comfort Promise strategies. Balancing measures included adverse drug reactions and vasoconstriction. We used statistical process control to analyze the outcome from 2 months preceding and 7 months following implementation. Results From January 1 to November 30, 2020, 21,600 encounters were identified, of which 10,294/21,600 (47.7%) were female. Age ranged from 0-17 years with a mean (SD) of 6.9 (5.5) years. Needle-related procedures were performed in 730/21,600 (3.4%) encounters, most commonly IV insertion (289/730, 39.6%) and venipuncture for blood sampling (232/730, 31.8%). Half of all encounters had no compliance strategies electronically recorded (363/730, 49.7%). Compliance with all Comfort Promise strategies increased over the study period (Figure 1). Topical anesthetic increased from 3/35 (8.6%) to 35/83 (42.2%). Sucrose or breastfeeding increased from 0/6 (0%) to 2/16 (12.5%). Comfort positioning increased from 0/35 (0%) to 26/83 (31.3%). Distraction increased from 0/35 (0%) to 22/83 (26.5%). There were no adverse drug reactions or vasoconstriction. Conclusion Implementation of The Comfort Promise in a Canadian paediatric ED resulted in greater use of strategies, particularly topical anesthetic, to reduce needle-related distress in children. Ongoing compliance will depend on consistent electronic recording and provider education.

Summer Outbreak of Severe RSV-B Disease, Minnesota, 2017 Associated with Emergence of a Genetically Distinct Viral Lineage.

Respiratory syncytial virus (RSV) typically causes winter outbreaks in temperate climates. During summer 2017, the Minnesota Department of Health received a report of increased cases of severe RSV-B infection. We compared characteristics of summer 2017 cases with those of 2014-2018 summers. To understand the genetic relatedness among viruses, we performed high-throughput sequencing of RSV from patients with a spectrum of illness from sites in Minnesota and Wisconsin. From May to September 2017, 58 RSV cases (43 RSV-B) were reported compared to 20-29 cases (3-7 RSV-B) during these months in other years. Median age and frequency of comorbidities were similar, but 55% (24/43) were admitted to the ICU in 2017 compared to 12% in preceding 3 years (odds ratio, 4.84, P < .01). Sequencing was performed on 137 specimens from March 2016 to March 2018. Outbreak cases formed a unique clade sharing a single conserved nonsynonymous change in the SH gene. We observed increased cases during the following winter season, when the new lineage was the predominant strain. We identified an outbreak of severe RSV-B disease associated with a new genetic lineage among urban Minnesota children during a time of expected low RSV circulation.

Containing a measles outbreak in Minnesota, 2017: methods and challenges.

We report on a measles outbreak largely occurring in Minnesota's under-vaccinated Somali community in the spring of 2017. The outbreak was already into its third generation when the first two cases were confirmed, and rapid public health actions were needed. The aim of our response was to quickly end transmission and contain the outbreak. The state public health department performed laboratory testing on suspect cases and activated an Incident Command staffed by subject matter experts that was operational within 2 h of case confirmation. Epidemiologic interviews identified exposures in settings where risk of transmission was high, that is, healthcare, childcare, and school settings. Vaccination status of exposed persons was assessed, and postexposure prophylaxis (PEP) was offered, if applicable. Exposed persons who did not receive PEP were excluded from childcare centers or schools for 21 days. An accelerated statewide measles, mumps, and rubella (MMR) recommendation was made for Somali Minnesota children and children in affected outbreak counties. Partnerships with the Somali Minnesota community were deepened, building off outreach work done with the community since 2008. Public health identified 75 measles cases from 30 March to 25 August 2017: 43% were female, 81% Somali Minnesotan, 91% unvaccinated, and 28% hospitalized. The median age of cases was 2 years (range: 3 months-57 years). Most transmission (78%) occurred in childcare centers and households. A secondary attack rate of 91% was calculated for unvaccinated household contacts. Over 51,000 doses of MMR were administered during the outbreak above expected baseline. At least 8490 individuals were exposed to measles; 155 individuals received PEP; and over 500 persons were excluded from childcare and school. State and key public health partners spent an estimated $2.3 million on response. This outbreak demonstrates the necessity of immediate, targeted disease control actions and strong public health, healthcare, and community partnerships to end a measles outbreak.

Building a Case for Pediatric Fall Prevention.

Falls are the leading cause of traumatic injury and injury-related emergency department visits in the state of Minnesota for children aged 0-14 years. We hypothesize that few of the Minnesota trauma centers and public health departments responsible for injury prevention (IP) efforts in the community are focusing on fall prevention interventions for children. The purpose of this study was to examine the current state of childhood IP interventions in Minnesota, identify potential partners to collectively address pediatric fall prevention, and utilize survey results to lead future IP efforts. An electronic survey was administered to state/American College of Surgeons verified trauma center and county health department staff in Minnesota. We compared opinions related to leading causes of traumatic injury, current IP efforts, data sources used to prioritize IP efforts, barriers to implementing childhood fall prevention interventions, and partnerships among trauma centers and health departments. Completed surveys were analyzed, with 37 responses from trauma centers and 25 from county health departments. On the basis of opinion, 47% of trauma center staff listed falls as the number one cause of traumatic injury to children compared with 25% of health department staff. Eighteen percent of survey respondents report that they have, or are, providing fall prevention programing. Limited resources were listed as the leading barrier. Significant variation exists regarding opinions related to the leading cause of pediatric traumatic injury. The feedback generated from this survey will be shared with Minnesota stakeholders in an effort to encourage collective action toward fall prevention interventions for Minnesota children.

982. Summer Outbreak of Severe RSV-B Disease, Minnesota, 2017

BackgroundRespiratory syncytial virus (RSV) causes seasonal outbreaks peaking from October to April in the United States. While symptoms are typically mild and limited to the upper respiratory tract in older children and adults, RSV can cause severe lower respiratory disease, hospitalization and death, particularly among younger children, the immunocompromised and the elderly. During summer 2017, the Minnesota Department of Health (MDH) received a report of a cluster of severe respiratory illness in children with RSV-B infection admitted at an urban county hospital.MethodsMDH conducts surveillance for RSV in Minneapolis-St. Paul with collection of respiratory specimens and clinical and demographic data. We compared characteristics of cases reported in summer 2017 with the previous 4 summer seasons. To understand the genetic relatedness among viruses, we performed complete genome sequencing from primary specimens using an Illumina MiSeq platform employing both a sequence-independent sequencing method and an RSV-specific, overlapping PCR-based approach.ResultsFrom May to September 2017, 58 cases of RSV (48 RSV-B) were reported to MDH compared with 18 (7 RSV-B) during the same period in 2016, 27 in 2015, and 29 in 2014. The median age and frequency of co-morbidities were similar across years; however, 50% required ICU admission in 2017 compared with 12% in preceding 3 years. The RSV-B genome was sequenced from 10 specimens from March to May 2016, 20 specimens from May to September 2017 and 30 specimens from October 2017-January 2018. Phylogenic analysis revealed that 15 cases from May to September. 2017 formed a unique clade distinct from the lineage encompassing 2016 cases from Minnesota and 35 representative complete RSV genomes in GenBank isolated from 6 continents over 13 years. From October 2017 to January 2018, we detected co-circulation of viruses from both lineages among older adults and children.ConclusionWe identified an outbreak of RSV-B associated with severe disease among urban Minnesota children during a time of expected low RSV circulation. Complete genome sequencing data suggested emergence of a new lineage distinct from viruses circulating in Minnesota during the previous season. Genomic characterization can provide useful insights into epidemiologic variations.Disclosures All authors: No reported disclosures.

May Hill Arbuthnot Honor Lecture: Rejoice the Legacy!

The May Hill Arbuthnot Honor Lecture was presented May 3, 2014, at the University of Minnesota Children’s Literature Research Collections on the university’s West Bank Campus.

Age-specific prevalence of Epstein-Barr virus infection among Minnesota children: effects of race/ethnicity and family environment.

Primary Epstein-Barr virus (EBV) infection affects the host differently according to when in life it is acquired. Understanding risk factors for infection could be important for disease prevention, and the age-specific prevalence of infection must be known to optimize use of a prophylactic vaccine. Children 18 months to 19.9 years of age who had blood drawn for medical indications during an outpatient visit were eligible. Sera were tested for immunoglobulin G antibodies against EBV viral capsid antigen by enzyme immunoassay. Family demographic and socioeconomic data were obtained via scripted telephone questionnaires. Consent was given for 876 of 914 (96%) subjects approached. Sera were available for 782 of 876 (89%) subjects and demographic/socioeconomic data obtained for 705 (90%) of them. Antibody prevalence, adjusted for age and sex, was as follows: non-Hispanic blacks, 74%; Asians, 62%, multiracial children, 54%; Hispanics, 50%; and non-Hispanic whites, 26%. The pattern of increases in antibody prevalence with age differed significantly by race/ethnicity, and was most divergent in the 2 youngest age groups. Adjusted EBV antibody prevalence decreased with greater household education among non-Hispanic whites, but was not associated with any other socioeconomic factor. In 42 of 51 (82%) families with >1 child in the study, the siblings' EBV antibody status was concordant (bootstrap P < .001). Racial/ethnic differences in EBV antibody prevalence and concordance of antibody status among siblings prompt us to speculate that both genetics and family environment contribute to acquisition of EBV infection. The ideal age to give a prophylactic vaccine may differ according to race/ethnicity.

Waning Immunity to Pertussis Following 5 Doses of DTaP

To assess the risk of pertussis by time since vaccination in children in Minnesota and Oregon who received 5 doses of acellular pertussis vaccines (DTaP). These cohort analyses included Minnesota and Oregon children born between 1998 and 2003 who had 5 DTaP doses recorded in state Immunization Information Systems. Immunization records and statewide pertussis surveillance data were combined. Incidence rates and risk ratios for pertussis were calculated for the 6 years after receipt of the fifth DTaP dose. The cohorts included 224,378 Minnesota children and 179,011 from Oregon; 458 and 89 pertussis cases were identified in Minnesota and Oregon, respectively. Pertussis incidence rates rose each year of follow-up: 15.6/100,000 (95% confidence interval [CI]: 11.1-21.4) at year 1 to 138.4/100,000 (CI: 113.3-166.9) at year 6 (Minnesota); 6.2/100,000 (CI: 3.3-10.6) in year 1 to 24.4/100,000 (CI: 15.0-37.8) in year 6 (Oregon). Risk ratios increased from 1.9 (CI: 1.3-2.9) in year 2 to 8.9 (CI: 6.0-13.0) in year 6 (Minnesota) and from 1.3 (CI: 0.6-2.8) in year 2 to 4.0 (CI: 1.9-8.4) in year 6 (Oregon). This evaluation reports steady increase in risk of pertussis in the years after completion of the 5-dose DTaP series. This rise is likely attributable in part to waning immunity from DTaP vaccines. Continuing to monitor disease burden and vaccine effectiveness in fully vaccinated children in coming years will be important to assess ongoing risk as additional cohorts vaccinated solely with acellular pertussis vaccines are introduced.

Measles Outbreak Management at a Minnesota Children's Hospital in 2011

Measles Outbreak Management at a Minnesota Children's Hospital in 2011

Group Offers Advice on Safe Extraction of Lead Wires in Implantable Heart Devices

cinations for nonmedical reasons. Because of the success of immunization, parents do not see the illness and death associated with these vaccinepreventable diseases and some are thus more likely to fear potential adverse effects of vaccination than the toll of the infections that the vaccines prevent, said Daniel A. Salmon, PhD, a coauthor of the Colorado study and vaccine safety specialist with the federal government’s National Vaccine Program in the Office of Public Health and Science. The public hears, for example, that some children have bad reactions to vaccines, do not develop immunity, or contract disorders that manifest themselves coincidentally following vaccination. These scenarios lead some parents to question the efficacy and safety of vaccines and to draw connections between immunization and increased risk of developing nonvaccination conditions. The changes in parents’ perceptions of disease pose a challenge for today’s vaccine programs, Salmon explained. Some parents believe there is a link between vaccination and autism, despite the numerous epidemiological studies that have failed to demonstrate such an association (Gerber JS and Offit PA. Clin Infect Dis. 2009;48[4]451-461 [http: //www.journals.uchicago.edu/doi/pdf /10.1086/596476]). Whatever the reason, choosing not to vaccinate has consequences because most vaccinepreventable diseases “are still around and reemerge when children are not vaccinated,” Salmon said. Paul A. Offit, MD, director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, had hoped last year’s outbreak of Haemophilus influenzae type b (Hib) in 5 Minnesota children—3 of whom had not received the Hib vaccine because of parental refusal or delay—would provide the anecdotal weapon needed to convince reluctant parents to agree to vaccination. “I thought the tipping point would be the Hib cluster in Minnesota, but children are still dying,” Offit said. “People still fear the vaccine more than the disease.” The resolution of that fear most likely will come from discussions between parents and their children’s pediatricians, said Harry L. Keyserling, MD, a member of the Committee on Infectious Diseases of the American Academy of Pediatrics (AAP). To aid in the discussion, the AAP issued a clinical report offering guidance to practitioners responding to parents who refuse vaccination (Diekema DS et al. Pediatrics. 2005;115[5]:1428-1431). Keyserling, who is also a professor of pediatrics at Emory University School of Medicine in Atlanta, said some pediatricians become so frustrated with reluctant parents that they want to drop these children as patients. That, he said, would be wrong. “Many physicians are uncomfortable taking care of parental refusers, but there is always the opportunity for the parents to change their minds,” Keyserling said. “So at each visit, the issue needs to be brought up again.”

Connecting Kids! Effective Recruitment for Resource Facilitation in the Pediatric Population

To describe and compare recruitment strategies to Resource Facilitation (RF) for children and youth with an incident traumatic brain injury. The universe of Minnesota children (0-14 years old) and youth (15-24 years old) with a traumatic brain injury, and discharge date in the year 2005. Using an observational study design, registry data were merged with the data sets kept for each method of contact. A total of 96% of this population had some form of contact; 12% participated in RF. With each added contact, participation consistently increased. Resource Facilitation recruitment needs to rely on multiple methods and multiple contacts to achieve the highest participation.

Comparison of recruitment, retention, and compliance results for three children's exposure monitoring studies

The School Health Initiative: Environment, Learning, Disease (SHIELD) study, the Minnesota Children's Pesticide Exposure Study (MNCPES), and the National Cooperative Inner-City Asthma Study (NCICAS) are three of the most intensive and invasive exposure-monitoring projects ever undertaken in children. An intrinsic facet of each study was the need to recruit children and their families, retain them for the duration of the project, and ensure that they completed monitoring protocols successfully. All of the studies used fiscal incentives to encourage participation, retention, and compliance. Recruitment rates varied from 40% in MNCPES, to 57% in SHIELD, to 64% in NCICAS, while retention rates varied from 85% in SHIELD, to 94% in MNCPES, to 95% in NCICAS. Rates of compliance with exposure sampling procedures were typically >80% for each study. For example, > or =85% of the enrolled children provided all requested urine samples (1 for NCICAS, 2 for SHIELD, 3 for MNCPES), and 82% of the children in SHIELD provided two out of two blood samples (optional in MNCPES and NCICAS). However, compliance rates were substantially lower (34% SHIELD, 40% NCICAS, not applicable to MNCPES) for the more complex and time-consuming protocol used to collect peak flow data. Overall, results demonstrate that it is practical and affordable to conduct demanding exposure-monitoring studies in children, including children from poor minority communities.

Constraining uncertainties about the sources and magnitude of polycyclic aromatic hydrocarbon (PAH) levels in ambient air: the state of Minnesota as a case study

Emissions data are often lacking or uncertain for many airborne contaminants. Polycyclic aromatic hydrocarbons (PAHs) emitted from combustion sources fall into this category. Currently available ambient-air emission inventories of PAHs either fail to account for population-based activities, such as residential wood combustion (RWC) and motor vehicle (MV) activity, and/or report “total PAH” or particulate organic matter emissions, instead of individual compound emissions. We assess the degree of overlap between predicted concentrations from estimated emissions with measured concentrations. Our analysis is based on probabilistic analysis of measured outdoor air concentrations with those predicted from mass-balance models. Based on available information, we estimate the relative magnitude of emissions from three major sources of PAHs to outdoor air: (1) on-road MVs, including light-duty gasoline vehicles and diesel-powered buses and medium and heavy-duty trucks; (2) RWC; and (3) power generation from external combustion boilers. We use the CalTOX regional multimedia mass-balance model to evaluate our emissions estimates in rural and urban regions of the state of Minnesota, USA. We compare model estimates of outdoor PAH airborne concentrations with those reported by the Minnesota Children's Pesticide Exposure Study (MNCPES). With these measured concentrations we probabilistically evaluate the reliability of our emissions estimates for specific PAHs. The median estimates of our predicted outdoor air concentrations agree within an order of magnitude of measured concentrations. For four representative PAHs, we obtain a reasonable degree of overlap between empirical and predicted distributions of outdoor air concentrations. Our combination of models, emissions estimates, and empirical concentration data estimate exposure in a manner that is more reliable than any of these tools alone. Thereby, we increase our confidence about our plausible ranges of emissions and predicted concentrations.

Where Child Care is Above Average? Licensing, Legislation, and Indicators of Quality of Care in Minnesota

Despite Minnesota's reputation for quality child care, recent changes in legislation and the impact of changing needs have raised concerns about the quality of child care available in the state. This paper presents an overview of Minnesota's current child care system including structural indicators of program quality such as licensing standards, staff wages, turnover, educational level, and program accreditation. The current situation is characterized by high levels of staff turnover, low wages, low levels of program accreditation, and increasing numbers of variances for child care licenses, all of which are disadvantageous to providing high quality child care to Minnesota's children. Efforts to decrease turnover through higher salaries and increase staff educational levels through tuition vouchers are explored. We find that there are a number of ways in which states can support quality child care, but stricter licensing standards are not likely to be sufficient by themselves.

Erratum: Assessment of the data quality for the NHEXAS—Part II: Minnesota children's pesticide exposure study (MNCPES)

Journal of Exposure Analysis and Environmental Epidemiology (2003) 13, 465–479. doi: 10.1038/sj.jea.7500315

Distributions, associations, and partial aggregate exposure of pesticides and polynuclear aromatic hydrocarbons in the Minnesota Children's Pesticide Exposure Study (MNCPES).

The Minnesota Children's Pesticide Exposure Study (MNCPES) provides exposure, environmental, and biologic data relating to multipathway exposures of children for four primary pesticides (chlorpyrifos, malathion, diazinon, and atrazine), 14 secondary pesticides, and 13 polynuclear aromatic hydrocarbons (PAHs). Monitoring was performed on a probability-based sample of 102 children aged 3-12 in Minneapolis/St. Paul and in a nearby rural area (Goodhue and Rice counties). This paper provides estimated distributions of this population's exposures and exposure-related measurements and examines associations among the various measures via rank (Spearman) correlations. In addition, it provides some aggregate and cumulative exposure estimates for pesticides, and compares the relative intakes from inhalation and dietary ingestion. Intakes for the four primary pesticides appeared to come principally from the ingestion rather than the inhalation route; this was clearly true for chlorpyrifos but was less certain for the other three primary pesticides because of their higher degree of nondetects. Solid food rather than beverages was clearly the main contributor to the ingestion intake. Despite the dominance of the ingestion route, the urinary metabolite of chlorpyrifos exhibited a stronger association with the air measurements than with the dietary measures. Personal-air samples exhibited strong rank correlations with indoor air samples for chlorpyrifos, malathion, and diazinon (0.81, 0.51, and 0.62, respectively), while personal-air atrazine levels correlated well with outdoor levels (0.69); personal-air diazinon levels also correlated well with outdoor levels (0.67). For the PAHs, many significant associations were evident among the various air samples and for the air samples with the dust samples, especially for those compounds with consistently high percent measurable values (particularly fluoranthene, phenanthrene, and pyrene).

Quantitative analysis of children's microactivity patterns: The Minnesota Children's Pesticide Exposure Study.

The National Human Exposure Assessment Survey (NHEXAS)/Minnesota Children's Pesticide Exposure Study (MNCPES) was a population-based study designed to characterize children's exposure to residential pesticides and to evaluate the contribution of residential and children's activities to children's exposure. Families of 168 children were surveyed for residential use of pesticides and children's activities. From these homes, families of 102 children between the ages of 3 and 13 years participated in a week-long intensive exposure study. Of the 102 children, 19 children were videotaped for four consecutive hours in their normal daily activities. The survey responses indicated that the youngest children were more likely to exhibit behaviors that would foster exposure to environmental contaminants. Comparison of questionnaire responses indicated that the videotaped subsample was representative of the exposure study population. The microactivities of the videotaped children that might contribute to their exposure via ingestion or dermal routes were quantified. Hand-to-mouth and object-to-mouth activities were observed most frequently among the youngest children. The youngest children were also most likely to be barefoot both indoors and outside. Gender differences were found in mouthing behavior and the proportion of observed time spent outdoors.

Measurement of children's exposure to pesticides: analysis of urinary metabolite levels in a probability-based sample.

The Minnesota Children's Pesticide Exposure Study is a probability-based sample of 102 children 3-13 years old who were monitored for commonly used pesticides. During the summer of 1997, first-morning-void urine samples (1-3 per child) were obtained for 88% of study children and analyzed for metabolites of insecticides and herbicides: carbamates and related compounds (1-NAP), atrazine (AM), malathion (MDA), and chlorpyrifos and related compounds (TCPy). TCPy was present in 93% of the samples, whereas 1-NAP, MDA, and AM were detected in 45%, 37%, and 2% of samples, respectively. Measured intrachild means ranged from 1.4 microg/L for MDA to 9.2 microg/L for TCPy, and there was considerable intrachild variability. For children providing three urine samples, geometric mean TCPy levels were greater than the detection limit in 98% of the samples, and nearly half the children had geometric mean 1-NAP and MDA levels greater than the detection limit. Interchild variability was significantly greater than intrachild variability for 1-NAP (p = 0.0037) and TCPy (p < 0.0001). The four metabolites measured were not correlated within urine samples, and children's metabolite levels did not vary systematically by sex, age, race, household income, or putative household pesticide use. On a log scale, mean TCPy levels were significantly higher in urban than in nonurban children (7.2 vs. 4.7 microg/L; p = 0.036). Weighted population mean concentrations were 3.9 [standard error (SE) = 0.7; 95% confidence interval (CI), 2.5, 5.3] microg/L for 1-NAP, 1.7 (SE = 0.3; 95% CI, 1.1, 2.3) microg/L for MDA, and 9.6 (SE = 0.9; 95% CI, 7.8, 11) microg/L for TCPy. The weighted population results estimate the overall mean and variability of metabolite levels for more than 84,000 children in the census tracts sampled. Levels of 1-NAP were lower than reported adult reference range concentrations, whereas TCPy concentrations were substantially higher. Concentrations of MDA were detected more frequently and found at higher levels in children than in a recent nonprobability-based sample of adults. Overall, Minnesota children's TCPy and MDA levels were higher than in recent population-based studies of adults in the United States, but the relative magnitude of intraindividual variability was similar for adults and children.

Measurement of Children's Exposure to Pesticides: Analysis of Urinary Metabolite Levels in a Probability-Based Sample

The Minnesota Children's Pesticide Exposure Study is a probability-based sample of 102 children 3-13 years old who were monitored for commonly used pesticides. During the summer of 1997, first-morning-void urine samples (1-3 per child) were obtained for 88% of study children and analyzed for metabolites of insecticides and herbicides: carbamates and related compounds (1-NAP), atrazine (AM), malathion (MDA), and chlorpyrifos and related compounds (TCPy). TCPy was present in 93% of the samples, whereas 1-NAP, MDA, and AM were detected in 45%, 37%, and 2% of samples, respectively. Measured intrachild means ranged from 1.4 microg/L for MDA to 9.2 microg/L for TCPy, and there was considerable intrachild variability. For children providing three urine samples, geometric mean TCPy levels were greater than the detection limit in 98% of the samples, and nearly half the children had geometric mean 1-NAP and MDA levels greater than the detection limit. Interchild variability was significantly greater than intrachild variability for 1-NAP (p = 0.0037) and TCPy (p &lt; 0.0001). The four metabolites measured were not correlated within urine samples, and children's metabolite levels did not vary systematically by sex, age, race, household income, or putative household pesticide use. On a log scale, mean TCPy levels were significantly higher in urban than in nonurban children (7.2 vs. 4.7 microg/L; p = 0.036). Weighted population mean concentrations were 3.9 [standard error (SE) = 0.7; 95% confidence interval (CI), 2.5, 5.3] microg/L for 1-NAP, 1.7 (SE = 0.3; 95% CI, 1.1, 2.3) microg/L for MDA, and 9.6 (SE = 0.9; 95% CI, 7.8, 11) microg/L for TCPy. The weighted population results estimate the overall mean and variability of metabolite levels for more than 84,000 children in the census tracts sampled. Levels of 1-NAP were lower than reported adult reference range concentrations, whereas TCPy concentrations were substantially higher. Concentrations of MDA were detected more frequently and found at higher levels in children than in a recent nonprobability-based sample of adults. Overall, Minnesota children's TCPy and MDA levels were higher than in recent population-based studies of adults in the United States, but the relative magnitude of intraindividual variability was similar for adults and children.

Blood pressure and arterial compliance in young adults: the Minnesota Children’s Blood Pressure Study

The aim of this study was to assess the relation between blood pressure (BP) and arterial compliance in a healthy sample of young adults. School children (aged 10 to 14 years at entry) were surveyed in 1977 to 1978, and 1207 were followed once to twice yearly until age 23 years. Arterial compliance was measured in 179 adults at the last follow-up visit. The sample included individuals in the upper tertile of systolic BP during the last three follow-up visits and race- and sex-matched individuals in the lower two tertiles. We obtained radial artery waveforms using a calibrated tonometer device and characterized waveform morphology to determine large artery (C 1) and oscillatory (C 2) compliance. Blood pressure was measured using random zero sphygmomanometers. The mean and standard deviation of C 1 was 2.13 ± 0.59 mL/mm Hg and of C 2 was 0.083 ± 0.02 mL/mm Hg. Systolic BP was inversely related to C 1 ( P < .001) and C 2 ( P < .01) after adjustment for gender, height, weight, insulin, and HDL and LDL cholesterol. After adjustment, a 1 SD change in systolic BP was associated with a −0.30 mL/mm Hg change in C 1 and a −.008 mL/mm Hg change in C 2. Data from the Minnesota Children’s Blood Pressure Study indicate that systolic BP is inversely related to arterial compliance, particularly C 1 (the large artery, or capacitive compliance).