Minnesota Community Research Articles

Nutrition services for pregnant adolescents within a public high school

The St. Paul Maternal and Infant Care Project (MIC) was begun in 1973 in response to the recognition that pregnant adolescents were medically, nutritionally, and socially at risk. The program provides prenatal care as well as adolescent health care and drug screening. It operates within 3 inner city public high schools and has a strong educational component for parents and for infants and children. Funds come from state-allocated Title V Maternal and Child Health funds, Title XIX EPSDT funds, and grants from the Minnesota Community Health Services Act and the St. Paul-Ramsey Hospital Medical Education and Research Foundation. Title XX monies are used to support the day care component. In-kind contributions from the St. Paul Schools provide physical facilities for the school health clinics and the day care center. Since implementation, the program has secured a 50% reduction in school fertility rates, there have been fewer obstetric complications, and a lower incidence of low-birth-weight infants compared with adolescents served by the MIC Project in non-school clinics. 85% have completed high school. The article then describes the nutritional problems of pregnant adolescents and the measures taken to deal with these.

The Community Corrections Act

Minnesota's Community Corrections Act, which became law in 1973, is examined in detail. Its development, fundamental precepts, and initial re sults are included. The act combined existing fragmented policies into a comprehensive strategy and defined the relationship between the state and local levels of government. It is based upon the assumptions that incarceration will continue to be needed for serious offenders, that local communities are in the best position to define community correction needs and programs, and that most offenders can remain in the community without loss of public protection. Thus far, the act has resulted in (1) a reduction in participating counties' adult and juvenile commitments to state institutions, (2) increased use of local correctional program alter natives, and (3) improved total planning for correctional programs. The Minnesota Community Corrections Act represents one solution to the problems confronting a state correctional system.

Incidence of Monoclonal Proteins in a Minnesota Community With a Cluster of Multiple Myeloma

Abstract Multiple myeloma was diagnosed in six residents of Thief River Falls, Minn. in 1968 (a rate of 84/100,000). A survey of the normal population for monoclonal serum protein peaks was undertaken in 1969. Serum from 1200 residents of the city, who were 50 yr of age or older, was collected. Fifteen (1.25%) had monoclonal serum protein peaks: IgG in 11, IgA in one, and IgM in three, with kappa in 11 and lambda in four. No clinical, laboratory, or roentgenographic evidence of myeloma or macroglobulinemia was found in any of the patients. The incidence of monoclonal serum protein peaks is similar to that reported from Sweden. It was concluded that there was no significant increase in monoclonal proteins in the population of Thief River Falls. The 1968 socalled epidemic of multiple myeloma in Thief River Falls remains unexplained.

Multiple Myeloma

In 1968, multiple myeloma was diagnosed in six residents of a Minnesota community (population 7,151). This is a rate of 84 per 100,000, as compared with an expected rate of about 3 per 100,000. The clinical and laboratory features of these cases were typical of myeloma. In addition, one case of Waldenstrom's macroglobulinemia was found during this period. The incidence of other forms of leukemia and lymphoma and of congenital malformation was not increased in the town during the years 1960 through 1968. The cause of this apparent community cluster of multiple myeloma cases remains obscure.

Location and Outpatient Psychiatric Care

IN 1954-55 93 percent of the professional services in Minnesota's outpatient psychiatric clinics were concentrated in metropolitan areas, and only 7 percent were provided for the 55.7 percent of the State's population residing in nonmetropolitan areas (1). Today, less than 3 years after passage of the Minnesota Community Mental Health Services Act of 1957, outpatient psychiatric care is available to 45 percent of all State residents within their own communities.. As provided in the act, more than half of Minnesota's 87 counties have received State grants-in-aid to esta.blish local mental health centers (2-4). In the evolving Minnesota community mental health program, 12 rural mental health centers serving 45 counties have been approved for State grants-in-aid. These centers serve populations ranging from approximately 116,000 to slightly less than 50,000 residents, and 10 are multicounty units serving from three to eight counties. The distance by road from a center to the farthest village within its service area ranges from 21 to 129 miles, with 47 miles the median distance. These facts illustrate a persistent problem in planning for outpatient mental health facilities: delineation of the geographic area which one center can serve adequately. While guidelines have established the size of the population best served by a full-time mental health team of psychiatrist, psychologist, and social worker, the literature reveals no s.uggestion of the optimum geographic area to be served by either the rural or the urban treatment center. Altman's study (5) of distances traveled for care from general practitioners and medical specialists in western Pennsylvania during 1950-51 offers relevant information, though psychiatric care is not among the categories of medical specialization for which the study presents specific data.. For patients who resided in eiglht counties adjacent to medium-sized metropolitan areas and who used the services of specialists, Altman showed that 59.4 percent lived within 5 miles, while only 11 percent traveled more than 40 miles for care. For the 27 countieis constituting the total studied, he showed a negative relation of 0.74 between average distance traveled and frequency with which specialists' services were obtained. Similarly, the mental health center a,t Crookston, Minn., reported for 1958-59 a negative relation of 0.79 between utiliza,tion and distance. This statistic, like Altman's, does not take into a,ccount those persons who failed to obtain services because of the distances involved.

The Minnesota Community: Country and Town in Transition

The Minnesota Community: Country and Town in Transition