Minnesota Community Research Articles

Safety Culture and Surgical Site Infection Outcomes After Abdominal Hysterectomy [342

INTRODUCTION: Previous studies demonstrate that hospital workplace culture may affect surgical outcomes. We designed a study evaluating the role of culture on surgical site infection after abdominal hysterectomy. METHODS: Data were collected from eight Minnesota community hospitals participating in a quality measurement collaborative from January 1 to December 31, 2012. Safety culture was measured using the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture instrument; surgical site infection was measured using National Healthcare Safety Network definitions. RESULTS: Median hospital size was 93 beds (range 57–426 beds) and mean survey response rate of staff was 44%. Rates of surgical site infection after abdominal hysterectomy ranged from 0% to 5.26%; median abdominal hysterectomy performed was 33 (range 10–276). Safety culture scores ranged from 16 to 92 on a scale of 0–100. Eight dimensions of safety culture were inversely associated with abdominal hysterectomy SSI rates: supervisor expectations and actions (r=−0.93; 95% CI [−0.66, −0.99]), teamwork across units (r=−0.87; 95% CI [−0.43, −0.98]), organizational learning (r=−0.87; 95% CI [−0.43, −0.98]), feedback and communication about error (r=−0.87; 95% CI [−0.41, −0.98]), overall perception of safety (r=−0.84; 95% CI [−0.34, −0.97]), management support for patient safety (r=−0.82; 95% CI [−0.27, −0.97]), frequency of event reporting (r=−0.77; 95% CI [−0.15, −0.96]), and teamwork within the unit (r=−0.77; 95% CI [−0.14, −0.96]). CONCLUSION: In a cohort of community hospitals, there was a strong association between safety culture and risk of abdominal hysterectomy surgical site infection. These data suggest a strong role for safety culture, teamwork culture, and engaged hospital management in creating high-quality surgical outcomes.

Abstract 15: Assessing Clinical Quality Indicators for Diabetes Care by Patient Home Zip Code

Objective: Quality of care for diabetes varies widely in the United States but is usually compared at the level of health facilities. As part of the HealthRise project, we analyzed ambulatory clinic data at the level of each patient’s residential zip code to determine whether achievement of risk factor targets is also a function of home neighborhood. Methods: Minnesota Community Measurement (MNCM) collects comprehensive patient-level clinical data from all non-federal ambulatory clinics in their state. Using MNCM data from the year 2013, we assessed risk factor targets for diabetes, defined as the percentage of adult diabetics seen at least twice in 12 months who achieved all of four risk factor targets (HbA1c < 8%, LDL<100 mg/dL, systolic blood pressure <140 mmHg and diastolic blood pressure <90 mmHg, and documented to be free of tobacco use). We aggregated the data to the zip code in which the patient resided for Hennepin, Ramsey, and Rice Counties, representing Minneapolis-St. Paul and a nearby rural county. Results: Success in meeting the HbA1c target was similar between counties, with 74.1% of patients in Hennepin, 74.4% in Ramsey, and 76.2% in Rice meeting the target. However, this varied widely at the zip code level. Across zip codes, the HbA1c target was achieved by 58.8% to 90.0% of patients and the LDL target by 46.7% to 83.6% of patients. Blood pressure and tobacco use targets were met by more patients (74.4% to 95.3% for blood pressure and 70.2% to 94.6% for tobacco). The lowest-performing zip codes were consistent across all four targets. Populations with the lowest achievement levels were found in the neighborhoods of North Minneapolis and Camden in Hennepin County, Downtown St. Paul, Southwest Downtown St. Paul, and South East Downton St. Paul in Ramsay County, and outlying rural areas in Rice County. Conclusion: Small-area geographies based on residential zip code appear to stratify the achievement of risk factor targets for diabetic patients in Hennepin, Ramsey and Rice Counties. Patients living in socioeconomically disadvantaged areas are less likely to achieve these clinical targets. Policies to improve cardiovascular risk factor control within clinics should also consider expanding their data collection to include the role of patients’ neighborhood environment.

Public reporting and the evolution of diabetes quality.

We address three questions related to public reports of diabetes quality. First, does clinic quality evolve over time? Second, does the quality of reporting clinics converge to a common standard? Third, how persistent are provider quality rankings across time? Since current methods of public reporting rely on historic data, measures of clinic quality are most informative if relative clinic performance is persistent across time. We use data from the Minnesota Community Measurement spanning 2007-2012. We employ seemingly-unrelated regression to measure quality improvement conditional upon cohort effects and changes in quality metrics. Basic autoregressive models are used to measure quality persistence. There were striking differences in initial quality across cohorts of clinics and early-reporting cohorts maintained higher quality in all years. This suggests that consumers can infer, on average, that non-reporting clinics have poorer quality than reporting clinics. Average quality, however, improves slowly in all cohorts and quality dispersion declines over time both within and across cohorts. Relative clinic quality is highly persistent year-to-year, suggesting that publicly-reported measures can inform consumers in choice of clinics, even though they represent measured quality for a previous time period. Finally, definition changes in measures can make it difficult to draw appropriate inferences from longitudinal public reports data.

Weight and Weight-Related Behaviors Among 2-Year College Students

Objectives and Participants: The purpose of this article is to describe weight indicators and weight-related behaviors of students enrolled in 2-year colleges, including sex differences. Methods: During Fall 2011 and Spring 2012, 441 students from 3 Minnesota community colleges enrolled in the Choosing Healthy Options in College Environments and Settings (CHOICES) Study and completed baseline assessments. Participants completed a baseline survey evaluating eating and activity patterns, sleep, and stress and measures of height, weight, waist circumference, and body fat. Results: Participants were primarily female (68%), white (73%), with a mean age of 22.8 years, and 66.2% reporting an annual income < $12,000. Almost half (47%) were overweight or obese. Young males appeared to engage the most in risky health behaviors and had higher levels of overweight or obesity, compared with young females. Conclusions: Findings confirm the need for innovative interventions targeting this understudied and underserved young adult population.

Putting out the welcome mat-targeting outreach efforts under the Affordable Care Act: Evidence from the Minnesota Community Application Agent Program.

An evaluation of the Minnesota Community Application Agent (MNCAA) Program was conducted for the MN Minnesota Department of Human Services and funded by the Health Resources and Services Administration's State Health Access Program grant. The MNCAA evaluation assessed effectiveness in reaching disparate populations, explored overall program value, and sought lessons applicable to the Navigator programs required under the Affordable Care Act. Mixed-methods approach using quantitative analysis of tracking and payment data and interviews with key informants to elicit "lessons learned" about the MNCAA program. The MNCAA program offers incentive payments and technical assistance to community partner organizations that assist individuals in applying for public health care coverage. A total of 140 unique community organizations participated in the MNCAA program in 2008 to 2012. Outreach staff and directors from participating MNCAAs and state/local government officials were interviewed. The article highlights a strategy for targeting outreach to individuals eligible for Medicaid coverage or subsidies under the Affordable Care Act by presenting evaluation findings from a unique outreach program to increase access to care for vulnerable populations in Minnesota. Almost two-thirds of applicants were successfully enrolled but lengthy waiting periods persisted. Seventy percent of applications came from health care organizations. Only 13% of applicants assisted by MNCAAs were new to public health care programs. Most MNCAAs believed that the incentive payment-$25 per successful enrollee-was insufficient. Significant expertise in enrolling individuals in public health care programs exists within a core group of community organizations. Incentives to leverage the capacity of community organizations must be accompanied by recruiting and training. Outreach providers and navigators also need timely access to client information. More investment in financial incentives will be required.

Health outcomes in diabetics measured with Minnesota Community Measurement quality metrics

ObjectiveOur objective was to understand the relationship between optimal diabetes control, as defined by Minnesota Community Measurement (MCM), and adverse health outcomes including emergency department (ED) visits, hospitalizations, 30-day rehospitalization, intensive care unit (ICU) stay, and mortality.Patients and methodsIn 2009, we conducted a retrospective cohort study of empaneled Employee and Community Health patients with diabetes mellitus. We followed patients from 1 September 2009 until 30 June 2011 for hospitalization and until 5 January 2014 for mortality. Optimal control of diabetes mellitus was defined as achieving the following three measures: low-density lipoprotein (LDL) cholesterol <100 mg/mL, blood pressure <140/90 mmHg, and hemoglobin A1c <8%. Using the electronic medical record, we assessed hospitalizations, ED visits, ICU stays, 30-day rehospitalizations, and mortality. The chi-square or Wilcoxon rank-sum tests were used to compare those with and without optimal control. We used Cox proportional hazard models to estimate the associations between optimal diabetes mellitus status and each outcome.ResultsWe identified 5,731 empaneled patients with diabetes mellitus; 2,842 (49.6%) were in the optimal control category. After adjustment, we observed that non-optimally controlled patients had higher risks for hospitalization (hazard ratio [HR] 1.11; 95% confidence interval [CI] 1.00–1.23), ED visits (HR 1.15; 95% CI 1.06–1.25), and mortality (HR 1.29; 95% CI 1.09–1.53) than diabetic patients with optimal control. No differences were observed in ICU stay or 30-day rehospitalization.ConclusionDiabetic patients without optimal control had higher risks of adverse health outcomes than those with optimal control. Patients with optimal control defined by the MCM were associated with decreased morbidity and mortality.

Is patient assessment of asthma care delivery associated with publicly reported performance measures?

Objective: To determine the association between patient assessment of healthcare delivery and publicly reported asthma performance measures. Methods: We identified individuals 5–50 years old who had asthma quality measures reported to the Minnesota Community Measurement© (MCM©) by their clinic and sent them a postal survey which included within it the Patient Assessment of Chronic Illness care (PACIC), a validated measure of patient perception of the quality of healthcare delivery. We performed a multivariable analysis to examine the association between PACIC scores and achievement of asthma care quality measures. Results: The response rate for the ACS was 102/367 (28%); a non-response bias analysis revealed no differences between responders and non-responders for age, gender and asthma control. Most responders (73%) reported taking asthma medications daily and most (71%) had poorly controlled asthma. The PACIC score was not associated with any of the asthma quality measures based on the data reported to MCM© by the clinic. A higher PACIC score was, however, associated with having an asthma action plan based on patient-reported data in the ACS (p < 0.0001) but not with patient-reported asthma control or emergency department/hospitalizations for asthma. Conclusions: Patient assessment of high quality asthma care delivery was associated with patient self-report of having an asthma action plan but was not associated with any of the publicly reported asthma performance measures.

Abstract P168: Primary Prevention of Cardiovascular Disease with Aspirin: Self-Reported and Validated Aspirin use in a Minnesota Community

Introduction: Aspirin (ASA) is recommended for the primary prevention (PP) of cardiovascular disease (CVD, defined as a first myocardial infarction or stroke) by the American Heart Association, Centers for Disease Control, and the U.S. Preventive Services Task Force. Rates of current ASA use for primary prevention of CVD are not well established. Furthermore, self-reported ASA use may be higher than actual use. We thus investigated self-reported and validated ASA use in a Minnesota population. Hypotheses: Current ASA use for primary prevention is low and self-report overestimates actual use. Methods: A population-based telephone survey was conducted of males 45-79 and females 55-79 years of age in a Minnesota community in 2012. Subjects were classified as PP or secondary prevention (SP) based on a history of CVD or previous cardiovascular procedures. Self-reported aspirin use was validated by measurement of serum thromboxane B 2 (sTXB 2 ), a stable metabolite of thromboxane A 2 , measured in a subset (n=54) using the Thromboxane B 2 EIA Kit (Cayman Chemical, Ann Arbor, MI) and reported as median (IQR). Results: A sample of 103 subjects (response rate 56%, age 64±9, 67% male) included both PP (n=74) and SP (n=29) cohorts. Risk factors were prevalent in both PP and SP groups: hypertension (41 vs 62%); diabetes (12 vs. 38%); hyperlipidemia (46 vs 76%); and current smoking (20 vs 23%). Daily aspirin use was reported by 37% of the PP vs. 76% of the SP groups. Within the PP group, most (96%) took aspirin to reduce the risk of CVD events. sTXB 2 levels were 165.6 (18.5, 250.1) ng/mL in aspirin non-users and were 2.8 (0.5, 12.0) ng/mL in self-reported aspirin users. A sTXB 2 cutpoint of 25 ng/mL to validate ASA exposure was associated with a sensitivity of 94% and specificity of 73%. Conclusions: Self-report of ASA use is a valid measure. Use is relatively low in a contemporary primary prevention population.

Minnesota Rural Palliative Care Initiative: Building Palliative Care Capacity in Rural Minnesota

Significant gaps exist in the availability of palliative care in rural hospitals and communities, even though rural populations are often disproportionately elderly and chronically ill. Few studies have examined what models of palliative care would be sustainable in a rural community. We studied the effects of a novel approach to palliative care program development with 10 rural Minnesota community teams over 18 months. The Minnesota Rural Palliative Care Initiative (MRPCI) included a three-prong framework consisting of community capacity theory, a learning collaborative model, and the National Quality Forum (NQF) Preferred Practices for Palliative and Hospice Care Quality. MRPCI confirmed the feasibility of building palliative care capacity in rural communities using this framework. By the end of the 18 months, all 10 teams had identified a target population, developed and refined an action plan, and included at least two strategies to address community needs or gaps related to NQF preferred practices. Only one community had an existing palliative care program at the start of the MRPCI. During the course of the collaborative, five additional communities built a core team to implement a palliative care program. Palliative care development is necessary in rural communities, and envisioning a program that combines structure, accountability, customized guidance, tools, and networking across settings is essential for success.

The Heart of New Ulm Project: Using Community-Based Cardiometabolic Risk Factor Screenings in a Rural Population Health Improvement Initiative

Awareness of cardiovascular disease and diabetes risk factors can improve the health of individuals and populations. Community-based risk factor screening programs may be particularly useful for quantifying the burden of cardiometabolic risk in a given population, particularly in underserved areas. This study provided a description of a screening platform and how it has been used to monitor the cardiometabolic risk profile within the broader Heart of New Ulm Project, which is based in a rural Minnesota community. A cross-sectional, descriptive examination of baseline screening data indicated that 45% of the target population participated in the program over 8 months. Overall, 13% of the sample reported a personal history of diabetes or cardiovascular disease. Among the subset without active cardiometabolic disease, 35% were found to be at high risk for developing cardiovascular disease or type 2 diabetes over the next 8-10 years. A high prevalence of metabolic syndrome, high low-density lipoprotein cholesterol, obesity, and low fruit/vegetable consumption were of particular concern in this community. This article describes the use of screening results to inform the design of intervention programs that target these risk factors at both the community and individual levels. In addition, design considerations for future community-based cardiometabolic risk factor screening programs are discussed, with a focus on balancing program objectives related to health surveillance, research, and the delivery of preventive health care services.

The Traveling Libby Legacy: Minnesota Community Exhibits Nonoccupational Health Impacts Consistent with Asbestos Damage

Vol. 120, No. 1 News | Science SelectionsOpen AccessThe Traveling Libby Legacy: Minnesota Community Exhibits Nonoccupational Health Impacts Consistent with Asbestos Damageis accompanied byRadiographic Evidence of Nonoccupational Asbestos Exposure from Processing Libby Vermiculite in Minneapolis, Minnesota Tanya Tillett Tanya Tillett Search for more papers by this author Published:1 January 2012https://doi.org/10.1289/ehp.120-a35aAboutSectionsPDF ToolsDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InReddit Adverse health effects of asbestos have been documented worldwide for the better part of the last half-century, with a large number of studies focused on occupational exposures received during the mining and processing of vermiculite ore. A new study reports on nonoccupational health effects resulting from community exposures to Libby vermiculite ore processed at the Western Minerals/W.R. Grace (WM/WRG) facility in Minneapolis, Minnesota [EHP 120(1):44–49; Alexander et al.].The WM/WRG plant is located in a residential neighborhood that includes a mix of single- and multifamily homes as well as schools and churches. During its years of operation from 1938 to 1989, residents were allowed to haul away waste rock for use in their yards, and children played on piles of waste rock outside the plant.Previous studies indicated an association between changes in lung function––a risk factor for asbestos-related disease—in children who reported playing on piles of waste rock in Libby, Montana, where this vermiculite ore was mined. In the current study, researchers analyzed radiographs of the lungs of 461 Minneapolis community members who were at risk for exposure to the WM/WRG vermiculite prior to 1980 (this date ensured an adequate latency period for any asbestos-related effects to manifest). The participants were part of the original Northeast Minneapolis Community Vermiculite Investigation cohort initiated by the Minnesota Department of Health and the U.S. Agency for Toxic Substances and Disease Registry.Archival photo of children playing on waste rock at the WM/WRG plant.Minnesota Department of HealthParticipants’ background asbestos exposures were estimated by coupling residential history with air dispersion and deposition models of the asbestos emitted from the plant when it was in operation. The researchers also asked participants about activity-based routes of exposure, such as having played as a child on the piles of waste rock outside the plant.Nearly half the participants reported engaging in at least one activity that brought them into contact with the waste material, and 39% reported having played on the waste rock piles. Radiographic evidence showed a 10.8% prevalence of pleural abnormalities consistent with pneumonoconiosis—evidence of asbestos-induced changes in the lungs—as determined by consensus of two radiologists certified to evaluate X rays for the effects of asbestos. Participants with pleural abnormalities were more likely to be male and were older, and those who reported frequently playing on waste rock piles had twice the prevalence of pleural abnormalities compared with those who reported never playing there. Pleural abnormalities also were more strongly associated with cumulative exposure estimated to have been acquired over many years than with higher intermittent peak exposures.Study limitations included small population size, imprecise estimations of activities leading to exposure, and analysis of only a single chest radiograph for each study subject. However, the results suggest that health effects associated with asbestos exposure may occur at lower levels than previously believed, pointing to the need for further research on the effects of long-term, low-level, and nonoccupational asbestos exposures.FiguresReferencesRelatedDetailsRelated articlesRadiographic Evidence of Nonoccupational Asbestos Exposure from Processing Libby Vermiculite in Minneapolis, Minnesota12 October 2011Environmental Health Perspectives Vol. 120, No. 1 January 2012Metrics About Article Metrics Publication History Originally published1 January 2012Published in print1 January 2012 Financial disclosuresPDF download License information EHP is an open-access journal published with support from the National Institute of Environmental Health Sciences, National Institutes of Health. All content is public domain unless otherwise noted. Note to readers with disabilities EHP strives to ensure that all journal content is accessible to all readers. However, some figures and Supplemental Material published in EHP articles may not conform to 508 standards due to the complexity of the information being presented. If you need assistance accessing journal content, please contact [email protected]. Our staff will work with you to assess and meet your accessibility needs within 3 working days.

Addressing Health Care Disparities Using Public Reporting

The literature highlights that disparities in health care performance exist. Publicly reporting data about disparities at an actionable level is needed. The Minnesota Health Care Disparities Report is designed to publicly report medical group health care performance rates for patients enrolled in state/federally funded programs. In addition, differences between patients enrolled in state-funded public programs and those in private or Medicare programs at statewide and medical group levels are presented. The endeavor is a cooperative one between Minnesota Community Measurement, an independent nonprofit community organization, and the Minnesota Department of Human Services, the state Medicaid agency. Public reporting makes transparent the gaps in the delivery of health care between patients enrolled in these programs at a medical group level and can facilitate quality improvement locally, where accountability lies and actions to address disparities can occur.

Sudden Acceleration of Diabetes Quality Measures

THE MODERN ERA IN DIABETES PERFORMANCE MEAsurement began in 1997, when the Diabetes Quality Improvement Project (DQIP), the first national disease-specific measure, set recommended thresholds for intermediate outcomes (glycated hemoglobin [HbA1c] levels, blood pressure, and low-density lipoprotein cholesterol [LDL-C] levels). These thresholds, if not achieved, would clearly result in greater population morbidity and mortality. The DQIP explicitly stated that such threshold measures were neither guidelines nor standards and that lower intermediate outcome values should not be used for public reporting owing to lack of evidence for efficacy and the absence of validated risk-adjustment models that would allow for fair comparisons. Also in the 1990s, major randomized trials such as the Diabetes Control and Complications Trial, Scandinavian Simvastatin Survival Study, United Kingdom Prospective Diabetes Study, West of Scotland Coronary Prevention Study, and Hypertension Optimal Treatment Study established stronger evidence for treatment of intermediate-outcome risk factors. These pivotal studies provided the impetus for studies conducted from 2000 onward to determine optimal values for these risk factors to reduce cardiovascular risk in patients with longer duration of disease. The successor to the DQIP, the National Quality Improvement Alliance (Alliance), made few major changes to the measure set from 2001 through 2005 other than to decrease threshold levels for HbA1c from 9.5% to 9.0% and for blood pressure from 140/90 mm Hg to 140/80 mm Hg and to add a threshold level for LDL-C of less than 100 mg/dL. The Alliance members, including liaisons from federal agencies and major professional societies, were aware that planned major trials would inform the choice of threshold values for optimal measures by the end of the decade. However, beginning in 2004, the National Committee for Quality Assurance (NCQA) added optimal measures for HbA1c, blood pressure, and cholesterol to the Diabetes Physician Recognition Program—HbA1c values less than 7%, blood pressure less than 130/80 mm Hg, and LDL-C values less than 100 mg/dL—which were adopted by the Bridges to Excellence pay-for-performance program. In 2005 the Minnesota Community Measurement Program developed a composite measure, termed the Diabetes 5 (D5), that was based on these optimal measures for HbA1c, blood pressure, and LDL-C; administration of aspirin; and nonsmoking status. Despite unanimous opposition from the Technical Advisory Panel of the Alliance, the NCQA approved the optimal measure set in May 2006. Even though inconsistent with guidelines from nonspecialty societies, these measures were widely viewed as evidence-based standards of care because they were based on the guidelines of specialty societies that lent their leadership to the industry-sponsored public service campaign. Coincidentally, 1 week after approval of the optimal measure set, scientific concerns were again raised at an Agency for Healthcare Research and Quality–sponsored conference on diabetes performance measures attended by representatives from key federal agencies, professional societies, the NCQA, and members of academic medicine. In addition to methodological concerns related to selection bias, lack of case-mix adjustment, patient preferences, and measurement variability, the possibility was raised of unintended—and unmeasured—consequences such as harms, costs, and polypharmacy. Indeed, only 2 months later the National Quality Forum did not endorse the “optimal measures.” Much has since changed. The glycemic treatment group in the ACCORD (Action to Control Cardiovascular Risk in Diabetes) study was prematurely terminated because of increased deaths in the intensive treatment group, and the NCQA measure was then modified. Then, the hypertension treatment approach in ACCORD failed to demonstrate benefit of tighter blood pressure control, resulting in modification of NCQA’s optimal measure of 130/80 mm Hg. Although the lipid treatment intervention was designed to evaluate the efficacy of fibrates, the subanalysis did not demonstrate benefit of lower lipid levels; however, this finding needs further evaluation. In the absence of new evidence from 1998 to 2008 and despite ongoing major trials

Patient care services in rural Minnesota community pharmacies

ObjectiveTo compare the availability of medication therapy management (MTM) services, point-of-care (POC) testing, and disease management resources between rural and urban Minnesota community pharmacies. DesignCross-sectional study. SettingMinnesota in 2006. ParticipantsOwners and operational managers of 564 Minnesota community pharmacies. InterventionMail survey containing structured, quantitative questions. Resulting data were separated to evaluate urban and rural area community pharmacies. Main outcome measuresStaffing trends, MTM services, and patient care services of urban compared with rural community pharmacies in Minnesota. ResultsUrban and rural pharmacies reported allocating nearly the same percent of a typical day to filling and dispensing prescriptions (∼70%). A higher percent of rural community pharmacies offered patient care services in 5 of 15 categories, including drug information services (55.7% vs. 45.6%), provision of durable medical equipment (43.4% vs. 32.6%), dyslipidemia management (7.8% vs. 3.8%), hypertension management (14.6%% vs. 7.3%), and MTM (29.4% vs. 18.7%). ConclusionAlthough the time allocated to dispensing medication was approximately 70% for both urban and rural pharmacies, a significantly higher proportion of rural pharmacies reported providing MTM and other direct patient care services. This may be a result of geographic isolation and greater use of pharmacists as providers of first-contact care in these areas.

Methods of Using Electronic Health Records for Population-Level Surveillance of Coronary Heart Disease Risk in the Heart of New Ulm Project

In Brief Although electronic health records (EHRs) were designed as individual-level documentation tools for patient-provider clinical interactions, some have advocated for their use in population-level health surveillance efforts. Limited research exists on this utility of EHRs, but some investigators have used them successfully to estimate the prevalence of chronic disease events and heart disease risk factors. This article reviews such studies and describes EHR use in the Heart of New Ulm project, a large 10-year intervention designed to reduce the incidence of myocardial infarctions and improve heart disease risk factors in a rural Minnesota community.

Running Shoe Selection Criteria Among Adolescent Cross-Country Runners

To determine which factors are most important to adolescent cross-country runners in selecting and replacing running shoes. A cross-sectional, descriptive survey. Surveys were completed at 4 high schools in a southeastern Minnesota community. Eligible subjects included adolescents (grades 7-12) participating in cross-country running at any of the 4 high schools in Rochester, Minnesota. A total of 223 surveys were distributed and collected from of an estimated 243 eligible participants. Independent variables included gender, running experience, grade, and previous injury history. A descriptive analysis of factors important in running shoe selection was performed. The assessment also included evaluation of the runners' knowledge of arch type and awareness of mileage accumulated before replacing running shoes. A total of 73.1% of survey participants identified arch type compatibility with shoe design as the most important factor in choosing a running shoe. However, only 57.0% reported knowing their arch type. A total of 74.0% reported not knowing how many miles they accumulated in a single pair of running shoes before replacement. A majority of adolescent runners in this study identified arch type and shoe design as the most important factors in choosing a running shoe.

Introduction to Botanical Medicine (Out of Print)

OPEN ACCESSJuly 6, 2006Introduction to Botanical Medicine (Out of Print) Dennis McKenna Dennis McKenna University of Minnesota Google Scholar More articles by this author https://doi.org/10.15766/mep_2374-8265.231 SectionsAbout ToolsDownload Citations ShareFacebookTwitterEmail AbstractThis web-based tutorial seeks to educate health care providers about botanical medicines and some issues surrounding their use. Written and reviewed by experts drawn from the University of Minnesota Medical School and community, it meets competencies for medical, nursing, and pharmacy education. Organized into sections, the self-study module provides definitions, a brief history of botanical use, the mechanism of action for botanicals, an overview of research and research issues, important information on regulation and manufacturing practices, and a summary of primary safety concerns. The module has interactive features, includes links to relevant organizations and a list of comprehensive references and concludes with a self-assessment quiz based on the learning objectives. These materials offer important information on complementary therapies, of which there is very little generally available. The online format matches well with new models of medical education that emphasize individualized learning and innovative tools. Online learning offers great flexibility to faculty and students. The individual online tutorials can be used in different courses in multiple ways; some faculty replace a reading assignment or class lecture with the online tutorial, then use class time for discussions arising from the tutorial. Other faculty use the tutorial as a resource for class projects. The tutorial is designed to allow direct access to any section, so learners can quickly find information relevant to their immediate needs. Educational Objectives By the end of the module, the learner will be able to: Define botanical medicines and dietary supplements.Discuss why it is important to know something about botanical medicines.List the 10 most common botanicals in the US and their common uses.Identify how long humans have used botanical medicines.Identify the percent of the world's population that still relies on botanicals.Discuss the cultural and historical influences on modern North American herbalism.Discuss the mechanism of action for botanical medicines.Compare botanical medicines to pharmaceutical drugs.Discuss what evidence base is needed for botanicals.List two key points concerning FDA regulation of botanical medicines. Sign up for the latest publications from MedEdPORTAL Add your email below FILES INCLUDEDReferencesRelatedDetails FILES INCLUDED Included in this publication: Web Link Access_231.pdf To view all publication components, extract (i.e., unzip) them from the downloaded .zip file. Download editor’s noteThis publication may contain technology or a display format that is no longer in use. CitationMcKenna D. Introduction to Botanical Medicine (Out of Print). MedEdPORTAL. 2006;2:231. https://doi.org/10.15766/mep_2374-8265.231 Copyright & Permissions© 2006 McKenna. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-No Derivatives license.KeywordsPhytotherapyPlantsCAMHerbologyHerbalHerbalism Disclosures None to report. Funding/Support None to report. Loading ...

Growth factor, cytokine, and vitamin D receptor polymorphisms and risk of benign prostatic hyperplasia in a community-based cohort of men

Objectives To investigate the associations between benign prostatic hyperplasia (BPH) and polymorphisms in genes that encode growth factors, cytokines, and vitamin D and their receptors. Methods A total of 510 white men (median age 60 years) randomly selected from the Olmsted County, Minnesota community participated in a study of BPH from 1990 to 2000. Biennial measurements were made to assess the International Prostate Symptom Score, peak urinary flow rate, and prostate volume. Genotyping of genes that encode transforming growth factor, interleukin-10, tumor necrosis factor, and vitamin D receptor, among others, was performed. Results The CC genotype of the transforming growth factor-beta 1 gene was inversely associated with treatment for BPH (hazard ratio [HR] 0.38, 95% confidence interval [CI] 0.15 to 0.98). The presence of at least one allele with 17 or more CA repeats of the epidermal growth factor receptor gene was positively associated with an International Prostate Symptom Score greater than 7 (HR 1.32, 95% CI 1.01 to 1.73). The AA genotype of tumor necrosis factor-alpha was inversely associated with peak urinary flow rate (HR 0.33, 95% CI 0.12 to 0.90). For the vitamin D receptor gene, positive associations were found between prostate volume and the CC genotype of the T_C (Taq 1) polymorphism (HR 1.39, 95% CI 1.0 to 1.92) and the AA genotype of the G_A (Bsm 1) polymorphism (HR 1.36, 95% CI 1.06 to 1.74). Conclusions These findings suggest that transforming growth factor-beta 1, tumor necrosis factor-alpha, epidermal growth factor receptor, and vitamin D receptor polymorphisms may be involved in the pathogenesis of BPH.

Patterns of Utilization for the Minnesota Senior Health Options Program

To compare the use of medical services provided under the Minnesota Senior Health Options (MSHO) (a special program designed to serve dually eligible older persons) with that provided to controls who received fee-for-service Medicare and Medicaid managed care. Quasi-experimental design using two control groups; separate matched cohort and rolling cross-sectional analyses; regression models used to adjust for case-mix differences. Urban Minnesota community and nursing home long-term care. Dually eligible elderly MSHO enrollees in the community and in nursing homes were compared with two sets of controls; one was drawn from nonenrollees living in the same area (control-in) and another from comparable persons living in another urban area where the program was not available (control-out). Cohorts living in the community and in nursing homes were included. Use of hospitals and emergency rooms, physician visits. In the community cohort, there were no significant differences in hospital admission rates or in hospital days. MSHO enrollees had significantly fewer preventable hospital admissions and significantly fewer preventable emergency services than the control-in group. MSHO nursing home enrollees had significantly fewer hospital admissions than either control group with or without adjustment at 12 and 18 months. MSHO enrollees had significantly fewer hospital days and preventable hospitalizations than the control-in group. MSHO enrollees had significantly fewer emergency room visits and preventable emergency room visits than either control group. In general, the results of this evaluation are mixed but favor MSHO. The effect of MSHO was stronger for nursing home enrollees than community enrollees. The lower rate of preventable hospitalizations and emergency room visits of MSHO enrollees suggests that MSHO affected the process of care by providing more of some types of preventive and community-care services for community residents.

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