Examining Excess Mortality Among Critical Workers in Minnesota During 2020-2021: An Occupational Analysis.

Objectives. To understand the occupational risk associated with COVID-19 among civilian critical workers (aged 16-65 years) in Minnesota. Methods. We estimated excess mortality in 2020 to 2021 for critical occupations in different racial groups and vaccine rollout phases using death certificates and occupational employment rates for 2017 to 2021. Results. Excess mortality during the COVID-19 pandemic was higher for workers in critical occupations than for noncritical workers. Some critical occupations, such as transportation and logistics, construction, and food service, experienced higher excess mortality than did other critical occupations, such as health care, K-12 school staff, and agriculture. In almost all occupations investigated, workers of color experienced higher excess mortality than did White workers. Excess mortality in 2021 was greater than in 2020 across groups: occupations, vaccine eligibility tiers, and race/ethnicity. Conclusions. Although workers in critical occupations experienced greater excess mortality than did others, excess mortality among critical workers varied substantially by occupation and race. Public Health Implications. Analysis of mortality across occupations can be used to identify vulnerable populations, prioritize protective interventions for them, and develop targeted worker safety protocols to promote equitable health outcomes. (Am J Public Health. 2023;113(11):1219-1222. https://doi.org/10.2105/AJPH.2023.307395).

Reducing avoidable hospital readmissions effectively: a statewide campaign.

BACKGROUND: The Reducing Avoidable Readmissions Effectively (RARE) Campaign was designed to engage hospitals and care providers in Minnesota across the continuum of care to prevent avoidable hospital readmissions within 30 days of hospital discharge. METHODS: Support for hospitals was provided on a one-on-one basis by a RARE resource consultant, as well as through the campaign website and a monthly newsletter. Hospitals had the opportunity to participate in any of three learning collaboratives-Care Transitions Intervention, Project RED (ReEngineered Discharge), or SAFE Transitions of Care. The operating and supporting partners of the RARE Campaign offered monthly webinars for sharing of best practices, and hosted Action Learning Days and celebratory events. Potentially preventable readmissions (PPRs) were tracked over time, and a ratio of actual-to-expected PPRs (A/E PPRs) was calculated for each hospital and reported quarterly. RESULTS: As of December 31, 2013, 82 hospitals were participating, with 58 (71%) taking part in at least one learning collaborative. More than 7,000 readmissions have been prevented, and patients have spent more than 28,000 nights of sleep in their own beds rather than in a hospital. By the end of September 2013, the A/E PPR ratio was reduced by 12%-from .98 to .86. CONCLUSIONS: The peer-to-peer networking and collaboration between hospitals facing similar issues, coupled with statewide resources, collaborating Operating Partners, and support for system improvements, have led to improved discharge planning, better management of care transitions and medications, engaged patients and families, and lower readmission rates.

COVID-19 Vaccine Hesitancy and Uptake among Firefighters: An Application of the Health Belief Model.

OBJECTIVE: To assess COVID-19 vaccination prevalence and explore whether health beliefs were associated with vaccination among firefighters. METHODS: A cross-sectional online survey was distributed to Minnesota firefighters in March - April 2022. Survey questions included demographics, vaccination status, and beliefs about COVID-19 and vaccines. RESULTS: Of the survey respondents (N = 974, 91% male, 89% White), 76% were fully vaccinated and 53% were boosted. Firefighters were less likely to be vaccinated if they reported more perceived barriers (OR = 0.42, p < .001), greater decision-making ease (OR = 0.42, p < .001), and greater autonomy (OR = 0.65, p = .04). Greater perceived benefits (OR = 2.63, p < .001) and social norms (OR = 2.10, p < .001) were associated with a greater likelihood of being vaccinated. Similar results were seen predicting booster status. CONCLUSIONS: Firefighters had similar vaccination rates as the general population, despite high exposure risks. Health beliefs are strongly related to vaccination status.

Implementation of CDC refugee blood lead testing guidelines in Minnesota.

The state of Minnesota undertook a trial of the 2005 recommendations for blood lead testing in refugees developed by the Centers for Disease Control and Prevention. New refugee children younger than 16 years of age receiving health screening at an urban clinic were tested for elevated blood lead levels (EBLLs) and nutritional status. Follow-up lead tests were obtained three to six months after the first test. During the course of the project, 150 refugee children received an initial blood lead test and nutritional blood tests, and 140 (93%) received a second blood lead test. Five children (3.3%) had EBLLs at the initial blood lead test and one child (0.7%) had an EBLL at the second test after a nonelevated first test result. In contrast to findings from New Hampshire, this project did not observe a high number of refugees who developed EBLLs after moving to the U.S.

Lead poisoning in Minnesota Medicaid children.

This article presents data on blood-lead testing in Minnesota children from 1999 through 2003. The number of Minnesota children younger than 6 years of age who were tested for blood lead increased from approximately 38,000 in 1999 to 61,000 in 2003. The rate of blood-lead testing in 9- to 30-month-old children enrolled in Medical Assistance and MinnesotaCare, the state's Medicaid programs for children, increased from 17% to 29% between 1999 and 2003. The rate of elevated blood-lead levels (10 microg/dL or greater) in all tested children declined from 6% in 1999 to 2.7% in 2003. However, the rate of elevated blood-lead levels in children enrolled in the 2 public programs in 2003 (3.4%) was 2-fold higher than that in children who were not on Medical Assistance or MinnesotaCare (1.5%). The percentage of all children with elevated blood-lead levels who were retested within 3 months increased from 39% in 1999 to 50% in 2003.

Prevalence of elevated blood lead levels and evaluation of a lead-risk-screening questionnaire in rural Minnesota.

The objectives of the study reported here were to determine the prevalence of elevated blood lead levels in rural Minnesota and to evaluate a lead-risk-screening questionnaire. Blood lead tests and lead risk questionnaires were obtained for a sample of 1,090 children younger than 48 months of age (72 percent of the eligible population) from three rural counties of west-central Minnesota between September 1, 2001, and August 31, 2002. It was found that overall, 2.4 percent of children in the study had blood lead levels of > or = 10 microg/dL (0.48 micromol/L) (results for capillary and venous tests combined), 0.9 percent had venous blood lead levels of > or = 10 microg/dL, and 0.5 percent of study participants had blood lead levels of > or = 20 microg/dL (0.96 micromol/L). Three risk factor questions, when taken together, predicted 90 percent of blood lead levels of > or = 10 microg/dL and all blood lead levels of > or = 20 microg/dL. The study estimated the prevalence of lead poisoning using a sample of the entire population rather than a clinic-based convenience sample. The authors conclude that targeted screening is an effective way to identify lead-poisoned children in rural areas of Minnesota.

Comparison of defects identified through Minnesota's Birth Defects Information System And Vital Records, 2006-2008.

The purpose of this study was to examine the differences in birth defects identified through passive and active surveillance systems in Hennepin and Ramsey counties in Minnesota, 2006-2008. This was done by comparing birth defects identified on birth certificates through the Minnesota Department of Health's Office of the State Registrar's Birth and Death Registry (vital records) with those identified by the Minnesota Department of Health's Birth Defects Information System (BDIS), an active birth defects surveillance system. The study population included 73,059 babies born to residents of Hennepin and Ramsey counties. There were 1,882 babies that either vital records and/or BDIS identified as having 1 or more birth defects. Cases identified by BDIS were then linked with matching birth certificates found in the vital records database. Using BDIS as the gold standard, it was observed that the vital records database had an overall underreporting rate of 89% when all broad groups of defects were compared, and 72% when 11 specific defects tracked by both registries were compared. The sensitivity and positive predictive values of vital records to identify cases were also compared using BDIS as the gold standard, and demonstrated low sensitivities for most of the 11 comparable defects (range: 0% for tracheoesophageal fistula to 80% for anencephalus). These observations indicate that BDIS has significantly improved the quality of birth defects surveillance in Minnesota.

Thyroid cancer and employment as a radiologic technologist.

The association between chronic occupational ionizing radiation exposure in the medical field and thyroid cancer is not well characterized. Thyroid cancer incidence was ascertained for 2 periods in a cohort of radiologic technologists certified for a minimum 2 years and enumerated in 1983: (i) cases identified prospectively in 73,080 radiologic technologists who were free of thyroid cancer at the baseline survey and completed a second questionnaire a decade later (N = 121), and (ii) cases occurring prior to cohort enumeration among 90,245 technologists who completed the baseline survey and were thyroid cancer free 2 years after certification (N = 148). Survival analyses estimated risks associated with employment as a radiologic technologist, including duration of employment, period of employment, types of procedures and work practices. The only occupational history characteristic associated with prospectively identified thyroid cancer was a history of holding patients for X-ray procedures at least 50 times (HR = 1.47, 95% CI = 1.01-2.15). Total years worked as a radiologic technologist, years performing diagnostic, therapeutic, and nuclear medicine procedures, employment under age 20 and calendar period of first employment were not associated with thyroid cancer risk. Risk of thyroid cancers diagnosed before the baseline questionnaire was inversely associated with decade first employed as a technologist, and was elevated, albeit imprecisely, among those working more than 5 years prior to 1950 (HR = 3.04, 95% CI = 1.01-10.78). These data provide modest evidence of an association between employment as a radiologic technologist and thyroid cancer risk; however, the findings require confirmation with more accurate exposure models.

Effects of aryl hydrocarbon receptor-mediated early life stage toxicity on lake trout populations in Lake Ontario during the 20th century.

Lake trout embryos and sac fry are very sensitive to toxicity associated with maternal exposures to 2,3,7,8-tetrachlorodibenzo-p-dioxin (TCDD) and structurally related chemicals that act through a common aryl hydrocarbon receptor (AHR)-mediated mechanism of action. The loading of large amounts of these chemicals into Lake Ontario during the middle of the 20th century coincided with a population decline that culminated in extirpation of this species around 1960. Prediction of past TCDD toxicity equivalence concentrations in lake trout eggs (TEC(egg)s) relative to recent conditions required fine resolution of radionuclide-dated contaminant profiles in two sediment cores; reference core specific biota--sediment accumulation factors (BSAFs) for TCDD-like chemicals in lake trout eggs; adjustment of the BSAFs for the effect of temporal changes in the chemical distributions between water and sediments; and toxicity equivalence factors based on trout early life stage mortality. When compared to the dose-response relationship for overt early life stage toxicity of TCDD to lake trout, the resulting TEC(egg)s predict an extended period during which lake trout sac fry survival was negligible. By 1940, following more than a decade of population decline attributable to reduced fry stocking and loss of adult lake trout to commercial fishing, the predicted sac fry mortality due to AHR-mediated toxicity alone explains the subsequent loss of the species. Reduced fry survival, associated with lethal and sublethal adverse effects and possibly complicated by other environmental factors, occurred after 1980 and contributed to a lack of reproductive success of stocked trout despite gradually declining TEC(egg)s. Present exposures are close to the most probable no observable adverse effect level (NOAEL TECegg = 5 pg TCDD toxicity equivalence/g egg). The toxicity predictions are very consistent with the available historical data for lake trout population levels in Lake Ontario, stocking programs, and evidence for recent improvement in natural reproduction concomitant with declining levels of persistent bioaccumulative chemicals in sediments and biota.