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1.
Gastroenterology ; 158(1): 151-159.e3, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31560892

RESUMO

BACKGROUND & AIMS: Celiac disease can develop at any age, but outcomes of adults with positive results from serologic tests for tissue transglutaminase antibodies (tTGA) without endoscopic determination of celiac disease (called celiac autoimmunity) have not been thoroughly evaluated. We investigated the proportion of adults with celiac autoimmunity at a community medical center and their progression to celiac disease. METHODS: We analyzed waste blood samples from a community clinic from 15,551 adults for tTGA and, if titer results were above 2 U/mL, for endomysial antibody. The blood samples had been collected at 2 time points (median interval, 8.8 years) from 2006 through 2017. We collected data from the clinic on diagnoses of celiac disease based on duodenal biopsy analysis. RESULTS: Of the serum samples collected at the first time point, 15,398 had negative results for tTGA, and 153 had positive results for tTGA (>4 U/mL). Based on medical records, 6 individuals received a diagnosis of celiac disease, for a cumulative incidence of celiac disease diagnosis of 0.06% (95% confidence interval, 0.01-0.11). Forty-nine (0.32%) individuals with a negative result from the first serologic test for tTGA had a positive result from the second test. Among the 153 adults who were tTGA positive at the first time point, 31 (20%) had a subsequent diagnosis of celiac disease, 81 (53%) remained positive for tTGA without a clinical diagnosis of celiac disease, and 41 (27%) had negative test results for tTGA at the second time point. Higher initial tTGA titers, female sex, and a history of hypothyroidism and autoimmune disease were associated with increased risks of subsequent diagnosis of celiac disease. Interestingly, adults whose first blood sample had a positive test result but second blood sample had a negative result for tTGA were older, had lower-than-average initial tTGA titer results, and had a higher mean body mass index than adults whose blood samples were positive for tTGA at both time points and adults later diagnosed with celiac disease. CONCLUSIONS: In an analysis of serum samples collected from a community clinic an average of 8.8 years apart, we found that fewer than 1% of adults with negative results from an initial test for tTGA have a positive result on a second test. Of adults with positive results from the test for tTGA, only 20% are later diagnosed with celiac disease; the remaining individuals maintain persistent increases in tTGA without diagnoses of celiac disease or have negative results from second tests.


Assuntos
Autoanticorpos/sangue , Autoimunidade , Doença Celíaca/epidemiologia , Centros Comunitários de Saúde/estatística & dados numéricos , Proteínas de Ligação ao GTP/imunologia , Transglutaminases/imunologia , Adulto , Autoanticorpos/imunologia , Biópsia , Doença Celíaca/diagnóstico , Doença Celíaca/imunologia , Progressão da Doença , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Estudos Prospectivos , Estudos Soroepidemiológicos
2.
JAAPA ; 33(1): 1-2, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31880656
3.
MMWR Morb Mortal Wkly Rep ; 68(47): 1096-1100, 2019 Nov 29.
Artigo em Inglês | MEDLINE | ID: mdl-31774740

RESUMO

During August 9-October 31, 2019, 96 patients were classified as having e-cigarette, or vaping, product use-associated lung injury (EVALI) by the Minnesota Department of Health (MDH); other patients are being investigated for case classification and exposures. Among 58 patients interviewed, 53 (91%) reported obtaining tetrahydrocannabinol (THC)-containing products from informal sources such as friends, family members, or in-person or online dealers. Using gas chromatography-mass spectrometry (GCMS), the MDH Public Health Laboratory (PHL) analyzed 46 THC-containing e-cigarette, or vaping, products obtained from 12 EVALI patients for various potential toxicants, including vitamin E acetate, which has recently been detected in some THC-containing products and in samples of lung fluid from EVALI patients (1-4). To explore whether vitamin E acetate is a recently added component in THC-containing products, MDH tested ten products seized by law enforcement in 2018, before the EVALI outbreak, and 20 products seized in 2019, during the outbreak. Twenty-four products obtained from 11 EVALI patients from 2019 contained vitamin E acetate. Among the seized products tested by MDH, none seized in 2018 contained vitamin E acetate, although all tested THC-containing products seized in 2019 tested positive for vitamin E acetate. These chemical analyses of products obtained from EVALI patients and of products intended for the illicit market both before and during the outbreak support a potential role for vitamin E acetate in the EVALI outbreak; however, the number of products tested was small, and further research is needed to establish a causal link between exposure to inhaled vitamin E acetate and EVALI. Collaboration between public health jurisdictions and law enforcement to characterize THC-containing products circulating before the recognition of the EVALI outbreak and during the outbreak might provide valuable information about a dynamic market. These Minnesota findings highlight concerns about e-cigarette, or vaping, products that contain THC acquired from informal sources. Because local supply chains and policy environments vary, CDC continues to recommend not using e-cigarette, or vaping, products that contain THC or any e-cigarette, or vaping, products obtained from informal sources. E-cigarette, or vaping, products should never be used by youths, young adults, or pregnant women.* Until the relationship between inhaled vitamin E acetate and lung health is better characterized, vitamin E acetate should not be added to e-cigarette, or vaping, products.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Legislação de Medicamentos , Lesão Pulmonar/epidemiologia , Vaping/efeitos adversos , Adolescente , Adulto , Idoso , Dronabinol/efeitos adversos , Dronabinol/análise , Feminino , Humanos , Aplicação da Lei , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Vitamina E/efeitos adversos , Vitamina E/análise , Adulto Jovem
4.
J Forensic Nurs ; 15(4): 222-230, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31764526

RESUMO

PURPOSE: The current study tests associations between reporting sexual victimization to a healthcare provider, campus authority, police, or social contact, and emotional well-being among college women. METHODS: Data from 2,162 women who participated in the 2015 College Student Health Survey at 17 colleges in Minnesota was used. Analyses tested associations between reporting sexual assault to formal or informal resources and diagnosis with anxiety, depression, panic attacks, and posttraumatic stress disorder, as well as self-rated health. RESULTS: Significantly higher rates of all four diagnoses were observed among those who reported to formal resources (e.g., healthcare provider, police) compared with those who reported to informal resources (i.e., friends, family). However, no differences were seen in self-rated physical or mental health. CONCLUSIONS: Expansion of trauma-informed healthcare services and advocacy efforts is recommended to optimally support students who report sexual assault experiences.


Assuntos
Vítimas de Crime/estatística & dados numéricos , Delitos Sexuais/estatística & dados numéricos , Estudantes , Adolescente , Adulto , Ansiedade/epidemiologia , Vítimas de Crime/psicologia , Depressão/epidemiologia , Feminino , Nível de Saúde , Humanos , Minnesota/epidemiologia , Transtorno de Pânico/epidemiologia , Delitos Sexuais/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Inquéritos e Questionários , Universidades , Adulto Jovem
5.
J Environ Qual ; 48(4): 988-994, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31589683

RESUMO

Successful N management practices for the US Midwest must optimize crop production and minimize NO-N losses from subsurface tile drainage. The objective of this study was to measure the effects of N rate, N application timing, and nitrapyrin [2-chloro-6-(trichlormethyl) pyridine] on corn ( L.) production and NO-N in tile drainage water in a corn-soybean [ (L.) Merr.] rotation in Minnesota. Anhydrous ammonia was applied at 90 and 179 kg ha with nitrapyrin in the fall and at 134 kg ha with and without nitrapyrin in fall and spring. However, drainage water monitoring was only conducted on fall treatments. Over a 5-yr period, 71% of drainage occurred in April through June and <1% occurred from November through March due to frozen soil. Averaged across N treatments and crops, annual drainage ranged from 69 to 380 mm among years. From 2001 through 2003, NO-N concentrations averaged 13.8, 15.6, and 20.0 mg L in corn and 7.3, 8.2, and 12.6 mg L in soybean when 90, 134, and 179 kg N ha was fall applied with nitrapyrin to corn, respectively. Corn grain yields were greater with spring-applied N at 134 kg ha (11.3 Mg ha) than with fall-applied N at 134 and 179 kg ha with nitrapyrin (10.5 and 10.8 Mg ha, respectively), and nitrapyrin did not affect corn production or water quality. Fall application of N is common on cold soils in Minnesota. These data showed that fall application required a greater rate of N to optimize yield than spring and that greater fall rate often increased NO-N concentration and load in tile drainage water.


Assuntos
Soja , Zea mays , Agricultura , Fertilizantes , Minnesota , Nitratos , Nitrogênio , Picolinas , Rotação , Solo
6.
Environ Sci Technol ; 53(20): 11725-11734, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31509695

RESUMO

Dissolved organic matter (DOM) composition influences its ability to form photochemically produced reactive intermediates (PPRI). While relationships have been established between bulk DOM properties and triplet DOM (3DOM) and singlet oxygen (1O2) quantum yields, contradictory evidence exists for hydroxyl radical (•OH) and hydroxylating species. Furthermore, little is known about these relationships at the molecular level. We evaluated DOM composition and photochemical reactivity of water samples from a wastewater treatment plant and the St. Louis River in Minnesota and Wisconsin, U.S.A. Bulk characterization using ultraviolet-visible spectroscopy demonstrates that color and apparent size of DOM decrease downstream, while molecular composition analysis using Fourier-transform ion cyclotron resonance mass spectrometry reveals that saturation and chemodiversity is highest near Lake Superior. 3DOM quantum yield coefficients and 1O2 quantum yields increase downstream and correlate strongly with saturated formulas. Similar results are observed for carbon-normalized photodegradation rate constants of atorvastatin, carbamazepine, and venlafaxine, which react primarily with 3DOM and 1O2. In contrast, •OH quantum yields are lowest downstream and correlate with less saturated, more oxygenated DOM, suggesting that 3DOM is not its major precursor. Mixed relationships are observed for DEET, which reacts with multiple PPRI. Molecular-level compositional data reveal insights into the differing formation pathways of individual PPRI, but information about specific contaminants is needed to predict their photochemical fate.


Assuntos
Compostos Orgânicos , Águas Residuárias , Minnesota , Rios , Wisconsin
7.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31501233

RESUMO

BACKGROUND AND OBJECTIVES: Food insecurity and pediatric obesity affect young children. We examine how food insecurity relates to obesity, underweight, stunting, health, and development among children <4 years of age. METHODS: Caregivers of young children participated in a cross-sectional survey at medical centers in 5 US cities. Inclusion criteria were age of <48 months. Exclusion criteria were severely ill or injured and private health insurance. The Household Food Security Survey Module defined 3 exposure groups: food secure, household food insecure and child food secure, and household food insecure and child food insecure. Dependent measures were obesity (weight-age >90th percentile), underweight (weight-age <5th percentile), stunting (height/length-age <5th percentile), and caregiver-reported child health and developmental risk. Multivariable logistic regression analyses, adjusted for demographic confounders, maternal BMI, and food assistance program participation examined relations between exposure groups and dependent variables, with age-stratification: 0 to 12, 13 to 24, 25 to 36, and 37 to 48 months of age. RESULTS: Within this multiethnic sample (N = 28 184 children, 50% non-Hispanic African American, 34% Hispanic, 14% non-Hispanic white), 27% were household food insecure. With 1 exception at 25 to 36 months, neither household nor child food insecurity were associated with obesity, underweight, or stunting, but both were associated with increased odds of fair or poor health and developmental risk at multiple ages. CONCLUSIONS: Among children <4 years of age, food insecurity is associated with fair or poor health and developmental risk, not with anthropometry. Findings support American Academy of Pediatrics recommendations for food insecurity screening and referrals to help families cope with economic hardships and associated stressors.


Assuntos
Desenvolvimento Infantil , Abastecimento de Alimentos/estatística & dados numéricos , Transtornos do Crescimento/epidemiologia , Nível de Saúde , Obesidade Pediátrica/epidemiologia , Magreza/epidemiologia , Afro-Americanos/estatística & dados numéricos , Fatores Etários , Arkansas/epidemiologia , Baltimore/epidemiologia , Boston/epidemiologia , Cuidadores/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Minnesota/epidemiologia , Inquéritos Nutricionais , Philadelphia/epidemiologia , Pobreza , Análise de Regressão
8.
J Dairy Sci ; 102(11): 10606-10615, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31477309

RESUMO

The objective of this study was to evaluate the effects of 2 winter (December to April) housing systems on dairy cow hygiene scores, frostbite, teat condition, clinical mastitis, and activity and rumination across 3 winter seasons (2013, 2014, and 2015). Certified-organic cows (n = 268) were randomly assigned to 2 treatments (2 replicates per system): (1) outdoor straw pack (outdoor) or (2) 3-sided compost-bedded pack barn (indoor). Cows calved during 2 seasons (spring or fall) at the University of Minnesota West Central Research and Outreach Center, Morris, Minnesota, organic dairy. Organic wheat straw was used as bedding for the 2 outdoor straw packs, and bedding was maintained by farm management to keep cows dry and absorb manure throughout the winter. The compost-bedded pack barn (2 pens in the barn) was bedded with organic-approved sawdust, and the bedding material was stirred twice per day with a small chisel plow. Hygiene scores were recorded biweekly as cows exited the milking parlor. Incidence of clinical mastitis was recorded in a binary manner as treated (1) or not treated (0) at least once during a lactation. Frostbite incidence was collected monthly. Activity and rumination times (daily and 2-h periods) were monitored electronically using a neck collar sensor (HR-LD Tags, SCR Dairy, Netanya, Israel). Indoor cows had greater udder hygiene scores (1.75 vs. 1.46) and greater abdomen hygiene scores (1.79 vs. 1.43) compared with outdoor cows. Additionally, the indoor cows had greater upper and lower leg hygiene scores compared with outdoor cows. Incidence of clinical mastitis was greater for indoor cows compared with outdoor cows (27.1% vs. 15.1%, respectively). Frostbite incidence was not different between indoor (30.1%) and outdoor (17.5%) cows. Daily rumination was 509 min/d for indoor cows and 530 min/d for the outdoor cows. In summary, lactating cows housed outdoors on straw-bedded packs had cleaner udders and improved udder health compared with cows housed in a compost-bedded pack barn.


Assuntos
Doenças dos Bovinos/prevenção & controle , Indústria de Laticínios , Congelamento das Extremidades/veterinária , Abrigo para Animais , Glândulas Mamárias Animais/fisiologia , Ruminação Digestiva , Animais , Bovinos , Feminino , Congelamento das Extremidades/prevenção & controle , Higiene , Israel , Lactação , Leite , Minnesota , Estações do Ano
9.
Mayo Clin Proc ; 94(9): 1825-1831, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31405749

RESUMO

OBJECTIVE: To compare survival by the presenting parkinsonism symptoms at diagnosis among patients with incident clinically diagnosed synucleinopathies. PATIENTS AND METHODS: Using the Rochester Epidemiology Project medical records-linkage system, we identified all persons residing in Olmsted County, Minnesota, who received a diagnostic code of parkinsonism from January 1, 1991, through December 31, 2010. A movement disorder specialist reviewed the complete medical records of each individual to confirm the presence of parkinsonism, determine the type of synucleinopathy, and identify the onset dates of each cardinal symptom (tremor at rest, bradykinesia, rigidity, and impaired postural reflexes). We determined the median time from age at diagnosis to death or censoring (June 30, 2015) for each presenting symptom and the age- and sex-adjusted risk of death. RESULTS: From 1991 through 2010, a total of 433 individuals had a synucleinopathy diagnosed (301 [69.5%], Parkinson disease; 68 [15.7%], dementia with Lewy bodies; 52 [12.0%], Parkinson disease dementia; and 12 [2.8%], multiple systems atrophy with parkinsonism). Overall, the risk of death in the tremor-predominant group was less than that in the bradykinesia/rigidity-only group (hazard ratio [HR], 0.59; 95% CI, 0.40-0.87; P=.007). Similarly, risk of death in the bradykinesia/rigidity-only group was significantly greater than in the tremor-predominant group (HR, 1.75; 95% CI, 1.23-2.51; P=.002) and compared with tremor before bradykinesia (HR, 1.75; 95% CI, 1.24-2.47; P=.001). CONCLUSION: Patients with tremor as a presenting symptom have longer survival. In contrast, the presence of bradykinesia/rigidity as a presenting symptom correlates with reduced survival across all types of synucleinopathies.


Assuntos
Doença de Parkinson/epidemiologia , Fenótipo , Vigilância da População , Tremor/fisiopatologia , Fatores Etários , Idoso , Bases de Dados Factuais , Progressão da Doença , Feminino , Humanos , Incidência , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Minnesota , Doença de Parkinson/fisiopatologia , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Análise de Sobrevida , /fisiopatologia , Tremor/epidemiologia
10.
J Manag Care Spec Pharm ; 25(9): 1026-1027, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31456494

RESUMO

DISCLOSURES: No outside funding supported the writing of this letter. Fendrick discloses consulting relationships with AbbVie, Amgen, Centivo, Community Oncology Association, Department of Defense, EmblemHealth, Exact Sciences, Freedman Health, Health at Scale Technologies, Health Management Associates, Lilly, MedZed, Penguin Pay, Risalto, Sempre Health, State of Minnesota, Wellth, and Zansors and also discloses a research relationship with AHRQ, Boehringer-Ingelheim, Gary and Mary West Health Policy Center, Laura & John Arnold Foundation, National Pharmaceutical Council, PCORI, PhRMA, RWJ Foundation, and State of Michigan/CMS. Shrosbree has nothing to disclose.


Assuntos
Assistência à Saúde/economia , Seguro/economia , Análise Custo-Benefício/economia , Custos de Cuidados de Saúde , Humanos , Michigan , Minnesota , Medicamentos sob Prescrição/economia
11.
S D Med ; 72(5): 206-213, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31454473

RESUMO

INTRODUCTION: Individual health is influenced by multiple, potentially correlated factors including healthcare availability, community context, and socioeconomic factors. To measure the health changes at county-levels across North Dakota, South Dakota, and Minnesota, a measure of relative health, health index, was developed incorporating multiple indicators from domains of health conditions, health behaviors, and social determinants. METHODS: We combined data from all 206 counties in the aforementioned three states for the years 2008-2012 from multiple data sources. We performed factor analysis that accounted for a hierarchical structure of the overall health index comprising of 15 indicators. RESULTS: A hierarchical structure is identified in which three intermediate factors are connecting the health index with 15 health indicators. The grouping results of the 206 counties based on health index values demonstrate the existence of a gradient in health conditions in the Northern Plains. CONCLUSIONS: The health status of urban areas was generally better than that of rural areas in the Northern Plains during this study period. The developed index adds stability to the estimates of the population characteristics, especially in rural, sparsely populated counties.


Assuntos
Comportamentos Relacionados com a Saúde , Nível de Saúde , Indicadores Básicos de Saúde , Humanos , Minnesota , North Dakota , South Dakota
12.
Water Res ; 165: 115001, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31470281

RESUMO

The ability of satellites to assess surface water quality indicators such as colored dissolved organic matter (CDOM) suggests that remote sensing could be a useful tool for evaluating water treatability metrics in considering potential drinking water supplies. To explore this possibility, 24 surface water samples were collected throughout Minnesota, USA with wide ranging values of CDOM (a440; 0.41-27.9 m-1), dissolved organic carbon (DOC; 5.5-47.6 mg/L) and specific ultraviolet absorbance at 254 nm (SUVA254; 1.3-5.1 L/mg-M). Laboratory experiments were performed to quantify chlorine demand and the formation of two classes of halogenated disinfection byproducts (DBPs), trihalomethanes (THMs) and haloacetic acids (HAAs), using the uniform formation conditions (UFC) test. Chlorine demand and THMUFC were linearly correlated with CDOM (R2 = 0.97 and 0.91, respectively), indicating that CDOM is a useful predictor of these parameters. On the other hand, data comparing di- and tri-HAAUFC with CDOM were better fit by a logarithmic relationship (R2 = 0.73 and 0.87, respectively), while mono-HAAUFC was linearly correlated with CDOM (R2 = 0.46) but only for low-to moderately-colored waters (a440 ≤ 11 m-1). The correlations relating chlorine demand and DBPUFC values with CDOM were coupled with satellite CDOM assessments to estimate chlorine demand and DBPUFC values for all surface waters larger than 0.05 km2 in the state of Minnesota, USA. The resulting maps suggest that only 21.8% of Minnesota lakes would meet both the THM and HAA maximum contaminant levels, but only when pre-disinfection treatment removes 75% of DBP precursors. There are limitations to determining CDOM using satellites for high color surface waters (a440 > 11 m-1), however, leading to underpredicted values for CDOM, chlorine demand, and DBPUFC. Overall, the results demonstrate the potential benefits of satellite remote sensing for assessing potential drinking water sources and water treatability metrics.


Assuntos
Desinfetantes , Poluentes Químicos da Água , Purificação da Água , Cloro , Desinfecção , Minnesota , Tecnologia de Sensoriamento Remoto , Trialometanos
13.
J Laparoendosc Adv Surg Tech A ; 29(10): 1285-1291, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31464567

RESUMO

Background: Operative maneuvers to increase mesenteric length during ileal pouch-anal anastomosis (IPAA) are frequently utilized in adults, but limited data exist on the need for their use in children. Materials and Methods: A retrospective chart review of children (age <18) considered for IPAA creation at two affiliated tertiary referral centers from 2007 to 2017 was conducted, and patient factors, operative details, and 30-day postoperative complications were abstracted. Body mass index (BMI) was normalized to BMI percentile-for-age-and-sex and classified as underweight (BMI <5th percentile), healthy weight (5th ≤ BMI percentile <85th), or overweight/obese (BMI ≥85th percentile). Maneuvers were identified from operative notes. Univariate analysis and multivariable logistic regression were performed to determine independent factors associated with the use of maneuvers. Results: A total of 94 patients underwent attempt at IPAA creation, which was successful in 91 (97%). Fourteen (15%) of 91 patients were classified as overweight or obese. The 3 failures occurred secondary to inability to reach in 3 patients, with specific mention of patients' obesity in 2 and pouch ischemia in 1. Sixty (66%) patients required maneuvers to lengthen the mesentery. Overweight/obese patients required maneuvers more often than nonoverweight/obese patients (93% versus 61%, P = .03). There were no differences in 30-day maximum Clavien-Dindo scores between patients with and without maneuvers performed (P = .83). Being overweight/obese was an independent risk factor for requiring maneuvers (odds ratio: 9.3, 95% confidence interval: 1.1-82.8) after adjusting for age, sex, height, operative stage, and surgeon. Conclusion: Surgeons should be prepared to perform mesenteric lengthening maneuvers when operating on pediatric patients to ensure minimal tension on the IPAA, and more so when operating on obese children. Whether these maneuvers have an impact on long-term pouch function is undetermined.


Assuntos
Polipose Adenomatosa do Colo/cirurgia , Colite/cirurgia , Mesentério/cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Utilização de Procedimentos e Técnicas/estatística & dados numéricos , Proctocolectomia Restauradora/métodos , Polipose Adenomatosa do Colo/complicações , Adolescente , Índice de Massa Corporal , Criança , Pré-Escolar , Colite/complicações , Feminino , Florida , Humanos , Lactente , Modelos Logísticos , Masculino , Minnesota , Obesidade Pediátrica/complicações , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento
14.
Mayo Clin Proc ; 94(8): 1542-1550, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31378229

RESUMO

OBJECTIVE: To describe the multifactorial etiologies of extreme thrombocytosis (EXT) in different care settings and the frequency of finding an occult malignancy. PATIENTS AND METHODS: We conducted a retrospective chart review at Mayo Clinic from January 1, 2011, through December 31, 2016. Adult patients who had at least 2 readings of platelet counts greater than 1000×109/L within 30 days of each other were included. We determined the causes of EXT on the basis of preset definitions of precipitating factors and identified the dominant causes on the basis of the trend of platelet counts. RESULTS: A total of 44,490 patients had thrombocytosis, and 305 patients (0.7%) had EXT. In 242 patients (79.3%), EXT was multifactorial. Surgical complications (54.1%) and hematologic malignancies (27.9%) were the 2 most dominant causes. Thirty-eight patients (12.5%) had new diagnoses of malignancies, mostly myeloproliferative neoplasms. In inpatients, surgical complications (71.9%), concurrent/previous splenectomy (50.5%), and infections (44.9%) were the most common causes, whereas hematologic malignancies (56.9%), iron deficiency (36.7%), and previous splenectomy (28.4%) were the most common causes in outpatients. Hematologic malignancy was 3.4 times more likely to be the cause of EXT in outpatients than in inpatients (56.9% vs 16.8%), and a new diagnosis of hematologic malignancy was 1.9 times more likely to be made in outpatients (15.6% vs 8.2%). Eighty-four percent of patients had resolution of EXT within 30 days. One patient died during the period of EXT. Nonsurgical patients with hematologic malignancies had the most prolonged period of EXT. CONCLUSION: Extreme thrombocytosis is a multifactorial hematologic condition, and its etiology differs substantially between inpatients and outpatients. Occult hematologic malignancies are uncommon in EXT when other major causes are present.


Assuntos
Neoplasias Hematológicas/complicações , Neoplasias Hematológicas/patologia , Complicações Pós-Operatórias/epidemiologia , Esplenectomia/efeitos adversos , Trombocitose/etiologia , Centros Médicos Acadêmicos , Adulto , Idoso , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Minnesota , Contagem de Plaquetas , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Esplenectomia/métodos , Taxa de Sobrevida , Trombocitose/mortalidade , Trombocitose/terapia
15.
Surgery ; 166(4): 556-563, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31378483

RESUMO

OBJECTIVES: To determine the long-term impact of vaccination on any postoperative infection in adults who underwent splenectomy. METHODS: All adults (≥18 years) who underwent splenectomy from 1965 to 2011 in Olmsted County, MN were identified using the Rochester Epidemiology Project. Descriptive statistics, Kaplan-Meier estimates, and Cox proportional hazard ratios were performed. RESULTS: There were 724 patients who underwent splenectomy; 47% were female with a median age of 55 (35-69) years. Overall vaccination rate (pneumococcal, H influenza, meningococcal) was 62% (n = 449). There were 268 (36%) patients who developed a post-splenectomy infection; most presented with sepsis 148 (55%). The 3 most common infections included pneumonia (124, 17%), bloodstream (67, 9%), and urinary tract infection (49, 7%). Median time to infection was quicker in non-vaccinated compared with vaccinated patients (1.5 [0.1-4.3] vs 3.3 [1.9-9.8] years, P = .01). CONCLUSION: In this population-based study, the highest risk of infection after splenectomy was in patients who did not receive complete vaccination. Lack of complete vaccination was associated with a reduced time to infection and increased rates of bloodstream infections at 5 years. Infectious complication risk reduced as vaccination protocols improved for all indications except for malignancy. Adults who underwent a splenectomy should continue to receive booster vaccines.


Assuntos
Esplenectomia/efeitos adversos , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Vacinação/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Bases de Dados Factuais , Feminino , Humanos , Incidência , Vacinas contra Influenza/administração & dosagem , Estimativa de Kaplan-Meier , Masculino , Vacinas Meningocócicas/administração & dosagem , Pessoa de Meia-Idade , Minnesota , Vacinas Pneumocócicas/administração & dosagem , Modelos de Riscos Proporcionais , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Fatores Sexuais , Esplenectomia/métodos
16.
Environ Manage ; 64(4): 483-496, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31392395

RESUMO

This study examines the social-psychological drivers of conservation practice adoption among farmers in Minnesota. Specifically, it applies a moral obligation model to understand farmer decision-making related to water resource management, focusing in particular on conservation tillage and drainage management. Data were collected through a self-administered mail survey of 1500 landowners in two subwatersheds of the Red River Basin: Wild Rice River and Middle Snake-Tamarac Rivers. Data were analyzed using structural equation modeling. Study results demonstrate that farmers' decisions to adopt conservation practices are influenced by personal norms and perceived ability to protect water resources. Further, beliefs about personal responsibility for water protection, and perceived ability to protect water resources activate personal norms of water protection. Collectivistic and biosphere-altruistic values serve as the basis for the activation of personal norms. Study findings suggest that a combination of behavioral intervention strategies that provide tailored information about local water resource problems, appeal to farmers' values, sense of responsibility and personal obligation, and enhance farmers' ability to use conservation practices may be effective in achieving higher levels of conservation practice adoption.


Assuntos
Conservação dos Recursos Hídricos , Fazendeiros , Agricultura , Conservação dos Recursos Naturais , Humanos , Minnesota , Obrigações Morais
17.
Ecology ; 100(12): e02856, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31381148

RESUMO

Forest ecosystems in eastern North America have been in flux for the last several thousand years, well before Euro-American land clearance and the 20th-century onset of anthropogenic climate change. However, the magnitude and uncertainty of prehistoric vegetation change have been difficult to quantify because of the multiple ecological, dispersal, and sedimentary processes that govern the relationship between forest composition and fossil pollen assemblages. Here we extend STEPPS, a Bayesian hierarchical spatiotemporal pollen-vegetation model, to estimate changes in forest composition in the upper Midwestern United States from about 2,100 to 300 yr ago. Using this approach, we find evidence for large changes in the relative abundance of some species, and significant changes in community composition. However, these changes took place against a regional background of changes that were small in magnitude or not statistically significant, suggesting complexity in the spatiotemporal patterns of forest dynamics. The single largest change is the infilling of Tsuga canadensis in northern Wisconsin over the past 2,000 yr. Despite range infilling, the range limit of T. canadensis was largely stable, with modest expansion westward. The regional ecotone between temperate hardwood forests and northern mixed hardwood/conifer forests shifted southwestward by 15-20 km in Minnesota and northwestern Wisconsin. Fraxinus, Ulmus, and other mesic hardwoods expanded in the Big Woods region of southern Minnesota. The increasing density of paleoecological data networks and advances in statistical modeling approaches now enables the confident detection of subtle but significant changes in forest composition over the last 2,000 yr.


Assuntos
Ecossistema , Florestas , Teorema de Bayes , Mudança Climática , Meio-Oeste dos Estados Unidos , Minnesota , Incerteza , Estados Unidos , Wisconsin
18.
Plant Dis ; 103(9): 2322-2329, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31298993

RESUMO

Rhizoctonia crown and root rot of sugar beet (Beta vulgaris L.), caused by Rhizoctonia solani, continues to be one of the important concerns for the beet industry in Minnesota and North Dakota. Use of resistant cultivars is an important strategy in the management of R. solani in combination with seed treatment and timely fungicide application during the growing season. The objective of this greenhouse study was to determine how sugar beet plants responded to increasing age in resistance to R. solani. Each of three seed companies provided three commercial cultivars with varying R. solani resistance levels: susceptible, moderately resistant, and resistant. Seed were planted at a weekly interval to create different plant age groups from seed to 10-week-old plants, with growing degree days (GDD) ranging from 0 to 1,519 thermal time (°Cd). Seed and plants were all simultaneously inoculated with R. solani AG2-2-infested barley grains. Twenty-eight days after inoculation, plants were pulled and washed, and roots were evaluated for disease severity. All cultivars were highly susceptible to R. solani when inoculated at seed to 3 weeks old (0 to 464°Cd). At 4 and 5 weeks of plant age (617 to 766°Cd), resistant cultivars started to show significant resistance to R. solani. Proportion of the affected roots with disease score ≥ 5 followed a sigmoid response, declining with increased GDD in moderately resistant and resistant cultivars, whereas it continued to decline linearly with increased GDD in susceptible cultivars. This study demonstrated that sugar beet cultivars, regardless of their assigned level of R. solani resistance, were highly susceptible to the pathogen before they reached the six- to eight-leaf stage at 4 to 5 weeks (617 to 766°Cd) after planting. Therefore, additional protection in the form of seed treatment or fungicide application may be required to protect sensitive sugar beet seed and seedlings in fields with a history of R. solani under favorable environmental conditions.


Assuntos
Beta vulgaris , Resistência à Doença , Rhizoctonia , Beta vulgaris/microbiologia , Resistência à Doença/fisiologia , Minnesota , North Dakota , Doenças das Plantas/microbiologia
19.
J Pediatr Ophthalmol Strabismus ; 56(4): 243-247, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31322715

RESUMO

PURPOSE: To report the incidence, demographics, and clinical manifestations of neurofibromatosis type 1 among a population-based cohort of patients. METHODS: The medical records of all patients diagnosed as having neurofibromatosis type 1 while residing in Olmsted County, Minnesota, from January 1, 1980, through December 31, 2009, were retrospectively reviewed. RESULTS: Fifty patients were diagnosed as having neurofibromatosis type 1 during the 30-year period, yielding an incidence of 1.2 per 100,000 individuals. The mean age at diagnosis was 11.7 years (95% confidence interval [CI]: 0.2 to 47) and 26 (52%) were males. Twenty-eight patients were new mutations, yielding a de novo mutation rate of 56%. During a mean follow-up of 9.8 years (range: 3 weeks to 32 years), café-au-lait macules were diagnosed in 49 individuals (98%), neurofibromas in 26 (52%), and skeletal anomalies in 14 (28%). Three (5.9%) individuals were diagnosed as having glioma of the central nervous system (95% CI: 1.2 to 9.7%) at a mean age of 13 years (range: 5 to 26 years), including 1 patient with optic nerve glioma diagnosed at the age of 26 years. Only 1 (2%) patient was diagnosed as having malignant nerve sheath tumor. CONCLUSIONS: Although the prevalence and de novo mutation rate of neurofibromatosis type 1 in this population-based study were similar to prior reports, the occurrence of optic nerve gliomas was much lower. [J Pediatr Ophthalmol Strabismus. 2019;56(4):243-247.].


Assuntos
Previsões , Neurofibromatose 1/epidemiologia , Vigilância da População , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Neurofibromatose 1/diagnóstico , Prevalência , Estudos Retrospectivos , Adulto Jovem
20.
J Vet Diagn Invest ; 31(5): 766-769, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31342882

RESUMO

Conjunctivitis is an uncommon finding in commercial swine herds, and the etiology of the disease is rarely studied. We investigated cases of conjunctivitis in 3 wean-to-finish swine farms. Eye swabs and tissues were obtained from clinically affected pigs (8-22 wk of age), from unaffected pigs in contact with affected pen-mates, and from age-matched pigs from an unaffected herd. Real-time PCR (rtPCR) testing for Mycoplasma hyorhinis demonstrated consistent detection and high bacterial load in samples from affected herds (clinically affected animals and non-clinical pen-mates). Ct values in affected pigs were 18.9-25.3; values were 36.4-38.6 in unaffected pigs from unaffected herds. Additionally, M. hyorhinis was identified within inflamed palpebral conjunctivae by in situ hybridization. The association of rtPCR and in situ detection of M. hyorhinis, along with the lack of detection of other potential pathogens and noninfectious causes, suggests the involvement of M. hyorhinis in the etiology and pathogenesis of the reported swine conjunctivitis.


Assuntos
Conjuntivite/veterinária , Surtos de Doenças/veterinária , Infecções por Mycoplasma/veterinária , Mycoplasma hyorhinis/isolamento & purificação , Doenças dos Suínos/epidemiologia , Animais , Conjuntivite/epidemiologia , Conjuntivite/microbiologia , Hibridização In Situ/veterinária , Minnesota/epidemiologia , Infecções por Mycoplasma/epidemiologia , Infecções por Mycoplasma/microbiologia , Ohio/epidemiologia , Oklahoma/epidemiologia , Reação em Cadeia da Polimerase em Tempo Real/veterinária , Suínos , Doenças dos Suínos/microbiologia
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