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1.
Ann Fam Med ; 21(1): 40-45, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36690491

RESUMO

PURPOSE: To learn whether the COVID-19 pandemic's disruptions and associated reduced health outcomes for people with chronic conditions might have been caused by a decrease in care management processes (CMPs) in primary care clinics METHODS: Longitudinal cohort design with repeated survey-based measures of CMPs from 2017, 2019, and 2021 in 269 primary care clinics in Minnesota. RESULTS: There were only small differences in organizational characteristics and no differences in overall CMPs between the 269 clinics analyzed and the 287 that only completed surveys in 1 or 2 years. Overall CMP scores rose by similar amounts (1.6% and 2.1%) from 2017 to 2019 and from 2019 to 2021. In 2021, CMP scores were lower in small medical groups than in large medical groups in 2017 (66.1% vs 78.5%, P <.001), a similar difference to that in 2017. Care management process scores were also lower in clinics in urban areas compared with rural areas (73.9% vs 79.0%, P <.001), but overall scores in all subgroups were higher in 2021 than in 2017. This improvement occurred despite reports from 55% of clinic leaders that the pandemic had been very or extremely disruptive. CONCLUSIONS: Although quite disrupted by the pandemic, care management processes for chronic disease care in these resilient primary care clinics actually increased from 2019 to 2021, at least in clinics that were part of large organizations. However, that was not true for clinics from smaller groups and perhaps for other areas of care.


Assuntos
COVID-19 , Pandemias , Humanos , Instituições de Assistência Ambulatorial , Minnesota , Doença Crônica , Atenção Primária à Saúde
2.
Am J Prev Med ; 64(2): 259-264, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36653101

RESUMO

INTRODUCTION: Recent research underscores the exceptionally young age distribution of COVID-19 deaths in the U.S. compared with that of international peers. This paper characterizes how high levels of COVID-19 mortality at midlife ages (45-64 years) are deeply intertwined with continuing racial inequity in COVID-19 mortality. METHODS: Mortality data from Minnesota in 2020-2022 were analyzed in June 2022. Death certificate data (COVID-19 deaths N=12,771) and published vaccination rates in Minnesota allow vaccination and mortality rates to be observed with greater age and temporal precision than national data. RESULTS: Black, Hispanic, and Asian adults aged <65 years were all more highly vaccinated than White populations of the same ages during most of Minnesota's substantial and sustained Delta surge and all the subsequent Omicron surges. However, White mortality rates were lower than those of all other groups. These disparities were extreme; at midlife ages (ages 45-64 years), during the Omicron period, more highly vaccinated populations had COVID-19 mortality that was 164% (Asian-American), 115% (Hispanic), or 208% (Black) of White COVID-19 mortality at these ages. In Black, Indigenous, and People of Color populations as a whole, COVID-19 mortality at ages 55-64 years was greater than White mortality at 10 years older. CONCLUSIONS: This discrepancy between vaccination and mortality patterning by race/ethnicity suggests that if the current period is a pandemic of the unvaccinated, it also remains a pandemic of the disadvantaged in ways that can decouple from vaccination rates. This result implies an urgent need to center health equity in the development of COVID-19 policy measures.


Assuntos
Vacinas contra COVID-19 , COVID-19 , Adulto , Humanos , Estados Unidos/epidemiologia , Minnesota/epidemiologia , COVID-19/prevenção & controle , Vacinação
3.
Health Aff (Millwood) ; 42(1): 140-149, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36623221

RESUMO

To facilitate safer prescribing of opioids and other drugs, nearly all states operate prescription monitoring programs (PMPs), which collect and share data on controlled substance dispensing. Policy makers have sought to raise clinicians' engagement with these programs but lack evidence on effective interventions. Working with the Minnesota Prescription Monitoring Program, we conducted a randomized trial to assess whether letters to clinicians increased program use and decreased risky coprescribing of opioids with benzodiazepines or gabapentinoids. In March 2021 we randomly assigned 12,000 coprescribers to either a control arm or one of three study arms sent differing letters. The respective letters highlighted a new mandate to check the PMP before prescribing, provided information about coprescribing risks with a list of coprescribed patients, or contained both messages combined. Letters highlighting the mandate alone or along with coprescribing information increased PMP search rates by 4.5 and 4.0 percentage points, respectively, with no significant effect on coprescribing. These letters also increased PMP account-holding rates among clinicians. Effects persisted for at least eight months. The letter with only coprescribing information had no detected effects on key outcomes. Our results support the use of simple letter interventions as evidence-based tools to increase PMP engagement and potentially facilitate better-informed prescribing.


Assuntos
Analgésicos Opioides , Programas de Monitoramento de Prescrição de Medicamentos , Humanos , Analgésicos Opioides/efeitos adversos , Padrões de Prática Médica , Prescrições de Medicamentos , Minnesota
4.
Am J Public Health ; 113(2): 213-223, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36480777

RESUMO

Objectives. To report insurance-based discrimination rates for nonelderly adults with private, public, or no insurance between 2011 and 2019, a period marked by passage and implementation of the Affordable Care Act (ACA) and threats to it. Methods. We used 2011-2019 data from the biennial Minnesota Health Access Survey. Each year, about 4000 adults aged 18 to 64 years report experiences with insurance-based discrimination. Using logistic regressions, we examined associations between insurance-based discrimination and (1) sociodemographic factors and (2) indicators of access. Results. Insurance-based discrimination was stable over time and consistently related to insurance type: approximately 4% for adults with private insurance compared with adults with public insurance (21%) and no insurance (27%). Insurance-based discrimination persistently interfered with confidence in getting needed care and forgoing care. Conclusions. Policy changes from 2011 to 2019 affected access to health insurance, but high rates of insurance-based discrimination among adults with public insurance or no insurance were impervious to such changes. Public Health Implications. Stable rates of insurance-based discrimination during a time of increased access to health insurance via the ACA suggest deeper structural roots of health care inequities. We recommend several policy and system solutions. (Am J Public Health. 2023;113(2):213-223. https://doi.org/10.2105/AJPH.2022.307126).


Assuntos
Cobertura do Seguro , Patient Protection and Affordable Care Act , Estados Unidos , Adulto , Humanos , Acesso aos Serviços de Saúde , Seguro Saúde , Minnesota
5.
Health Aff (Millwood) ; 41(12): 1694-1699, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36469832

RESUMO

As a hub for local collaboration, a Minneapolis, Minnesota, health system empowers patients by giving them resources to address their health-related social needs.


Assuntos
Programas Governamentais , Humanos , Minnesota
6.
JACC Clin Electrophysiol ; 8(12): 1566-1575, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36543507

RESUMO

BACKGROUND: Recognition of the causes of early mortality (≤30 days) after transvenous lead removal (TLR) is an essential step for the development of quality improvement programs. OBJECTIVES: This study sought to determine the causes of early mortality after TLR and to further understand the circumstances surrounding death after TLR. METHODS: A retrospective analysis was performed of all patients undergoing TLR from January 1, 2001, to January 1, 2021, at the Mayo Clinic (Rochester, Minnesota; Phoenix, Arizona; and Jacksonville, Florida). Causes of death were identified through a detailed chart review of the electronic health record from within the Mayo Clinic system and outside records when available. The causes of death were further characterized based on whether it was related to the TLR procedure. RESULTS: A total of 2,319 patients were included in the study. The overall 30-day all-cause mortality rate was 3% (n = 69). Among all 30-day deaths, infection was the most common primary cause of death (42%). This was followed by decompensated heart failure (17%), procedure-related death (10%), sudden cardiac arrest (7%), and respiratory failure (6%). The 30-day mortality rate directly due to complications associated with the TLR procedure was 0.3%. One-third of deaths (33%) occurred after discharge from the index hospitalization; among these, 43% were readmitted before their death, 35% died at home or at a nursing facility, and 22% were discharged on comfort care and died in hospice. The main reasons for readmission before death were sepsis and decompensated heart failure. CONCLUSIONS: The majority (90%) of 30-day mortality after TLR was not due to complications associated with TLR procedures. The primary causes were infection and decompensated heart failure. This highlights the importance of increased emphasis on postprocedure management of infection and heart failure to reduce postoperative mortality, including after hospital discharge.


Assuntos
Insuficiência Cardíaca , Hospitalização , Humanos , Estudos Retrospectivos , Fatores de Risco , Insuficiência Cardíaca/cirurgia , Minnesota/epidemiologia
7.
Alzheimers Dement ; 18 Suppl 9: e061143, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36537943

RESUMO

BACKGROUND: Dementia is a growing problem that is the cause for an increase in care provision needs. Staff shortages are having an adverse effect by creating an atmosphere where the people affected with dementia feel neglected and isolated. This is resulting in reduced quality of life for the people residing in assisted living facilities and nursing homes. Family members and caregivers have been forced to reduce contact with the residents due to the fear of infection given the vulnerability of the residents. The residents are losing emotional stimulation and this is adversely affecting their disease progression. METHOD: Freeing caregivers of mundane caregiving activities that require more patience and less caregiving in activities such as reminding/prompting, watching and monitoring can allow them to focus on activities that require more attention and will benefit the residents. Repetitive activities such as prompting, reminding of daily living activities such as brushing teeth and hair, washing hands, keeping the oxygen or face mask on etc. can be repetitive and stressful for caregivers. If these activities can be performed by a humanoid robot that can repeat the same activity or prompt without getting frustrated or changing the tone, the caregivers will have more time to tend to activities that require more attention such as medication management, tending to finances, medical followup appointments etc. University of Minnesota is collaborating with nursing homes in deploying robots to help augment care in the domains of emotion, cognition and physical wellbeing. These robots will have tasks assigned to them that they will perform throughout the day. They work in conjunction with sensors that will provide them with stimulation and feedback for tracking and monitoring activities of daily living. The sensors will also track the physiological well being to ensure the residents are not adversely affected by the robots. RESULT: Humanoid robots are being deployed in nursing homes. A combination of humanoid robots and wearable and spatial sensors track and monitor care provision for residents at nursing homes. CONCLUSION: The humanoid robots are helping fill staff shortage gaps. Most importantly residents feel more engaged and have an improved sense of wellbeing.


Assuntos
Demência , Robótica , Humanos , Qualidade de Vida , Minnesota , Atividades Cotidianas , Demência/psicologia , Casas de Saúde
8.
J Bone Joint Surg Am ; 104(23): e100, 2022 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-36476739

RESUMO

BACKGROUND: The National Institutes of Health (NIH) remains one of the predominant sources of biomedical research funding in the United States, yet its impact on total hip and knee arthroplasty research is poorly understood. This study defines the portfolio of NIH funding for total joint arthroplasty (TJA) and the impact of orthopaedic surgeons on this portfolio. METHODS: The Research Portfolio Online Reporting Tools Expenditures and Results (RePORTER) database was queried for NIH grants that had been awarded for total hip and knee arthroplasty and total NIH funding from 2010 to 2020. Compound annual growth rates (CAGRs) were calculated. Funding totals were compared with those from 20 other clinical areas. The principal investigators (PIs) and grants were characterized, and comparisons were made with use of the Student t test. RESULTS: A total of 489 grants were awarded, totaling $181 million (CAGR of 10.3%). This was >3 times the growth rate for the total NIH budget (CAGR of 2.9%), which increased from $31.2 to $41.7 billion over the 11-year period. When compared with 20 other clinical areas, TJA received the least amount of NIH funding over that period. Alzheimer disease received the most funding ($12.1 billion, CAGR of 19.5%), and cerebral palsy received the penultimate amount of funding ($284 million, CAGR of 6.3%). The R01 grant mechanism was the predominant source (63.1%), and the Mayo Clinic (Rochester, Minnesota) received the most funding (9.7%). Departments of orthopaedic surgery were awarded the most funding (23.5%), yet only 20 orthopaedic surgeons were identified as PIs (16.0%). There were no significant differences in NIH funding totals by PI demographic and academic characteristics (p > 0.05), yet orthopaedic surgeons had among the highest Hirsch indices (h-indices) (p < 0.001). Funding supported clinical (63.5%), translational (19.3%), basic science (7.1%), and other types (10.1%) of research. The top areas with funding were postoperative complications (44.4%), postoperative pain management (17.6%), rehabilitation (15.1%), and implant design (12.4%). CONCLUSIONS: There is a paucity of orthopaedic surgeon representation among NIH grants awarded for TJA. Opportunities may exist for orthopaedic surgeons to collaborate in identified areas of clinical interest. Additional research is needed to understand the obstacles to obtaining NIH grant funding for orthopaedic surgeon PIs. CLINICAL RELEVANCE: Increasing the levels of funding from the NIH is a strategic priority for departments of orthopaedic surgery. Understanding levels of funding for clinical areas in total joint arthroplasty is critical to foster research and discovery support from the NIH.


Assuntos
Pesquisa Biomédica , National Institutes of Health (U.S.) , Estados Unidos , Humanos , Minnesota
9.
Mayo Clin Proc ; 97(12): 2282-2290, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36347648

RESUMO

OBJECTIVE: To characterize the epidemiological trends and mortality of cutaneous lupus erythematosus (CLE) between 1976 and 2018 in Olmsted County, Minnesota. PATIENTS AND METHODS: In this retrospective population-based cohort study, all incident and prevalent CLE cases among adult residents in Olmsted County, Minnesota, between January 1, 1976, and December 31, 2018, were identified and categorized by subtype through medical record review using the resources of the Rochester Epidemiology Project. RESULTS: The overall incidence rate of CLE between 1976 and 2018 was 3.9 (95% CI, 3.4 to 4.5) per 100,000. The incidence of CLE was relatively stable, with no major trend across sexes or age groups. The age- and sex-adjusted prevalence of CLE was 108.9 per 100,000 on January 1, 2015. Mortality in CLE patients was similar to that of the general population, with a standardized mortality ratio of 1.23 (95% CI, 0.88 to 1.66) with no observed trends in mortality over time. CONCLUSION: In the past 4 decades, the incidence of CLE remained stable. Patients with CLE have mortality comparable to that of the general population.


Assuntos
Lúpus Eritematoso Cutâneo , Adulto , Humanos , Estudos de Coortes , Estudos Retrospectivos , Lúpus Eritematoso Cutâneo/epidemiologia , Incidência , Prevalência , Minnesota/epidemiologia
10.
JAMA Health Forum ; 3(11): e224149, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36399352

RESUMO

Importance: Buprenorphine is an approved medication for opioid use disorder (MOUD); however, prescribing buprenorphine is limited by a requirement to obtain a waiver to prescribe it (hereinafter, "DATA [Drug Abuse Treatment Act]-waiver") and a lack of knowledge of the best practices among clinicians. Objective: To examine how Project ECHO (Extension for Community Healthcare Outcomes) telementoring is associated with changes in DATA-waiver attainment and buprenorphine prescribing among primary care clinicians in Minnesota. Design, Setting, and Participants: In this retrospective matched-cohort study of 918 clinicians, ECHO-trained clinicians were enrolled on the date they first attended ECHO (January 3, 2018, to June 11, 2020); comparison clinicians were assigned an enrollment date from the distribution of the first ECHO sessions. The baseline period was 12 months preceding enrollment, with follow-up for 18 months or until June 30, 2020. The ECHO-trained clinicians were a population-based sample of primary care clinicians who treated Medicaid patients in Minnesota 12 months prior to the initiation of ECHO training. This analysis used propensity score matching to select comparison clinicians who were similar across demographic and clinical practice characteristics at baseline in a 2:1 ratio. Follow-up was available for 167 ECHO-trained clinicians (54.6%) and 330 comparison clinicians (53.9%) at 18 months. Exposures: ECHO-trained clinicians attended at least 1 weekly, hour-long ECHO session. Comparison clinicians never participated in any ECHO sessions. Main Outcomes and Measures: DATA-waiver attainment, any buprenorphine prescribing, and the percentage of patients with opioid use disorder (OUD) who were prescribed buprenorphine. Results: The final sample included 918 clinicians (ECHO-trained [306]; comparison [612]), of whom 620 (67.5%) practiced outside the metropolitan Twin Cities (Minneapolis-St Paul) region. The mean (SD) age of the ECHO-trained clinicians was 46.0 (12.1) years and that of the comparison clinicians was 45.7 (12.3) years. Relative to the changes among the matched comparison clinicians, the ECHO-trained clinicians were more likely to obtain a DATA-waiver (difference-in-differences, 22.7 percentage points; 95% CI, 15.5-29.9 percentage points; P < .001) and prescribe any buprenorphine (16.5 percentage points; 95% CI, 10.4-22.5 percentage points; P < .001) after 6 quarters of follow-up. ECHO-trained clinicians prescribed buprenorphine to a greater share of patients with OUD (a difference of 7.6 percentage points per month; 95% CI, 4.6-10.6 percentage points per month; P < .001), relative to that prescribed by the comparison clinicians. Conclusions and Relevance: According to the findings of this matched-cohort study, ECHO telementoring may be associated with greater prescribing of buprenorphine by primary care clinicians. These findings suggest that Project ECHO training could be a useful tool for expanding access to MOUD.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Humanos , Estados Unidos , Pessoa de Meia-Idade , Buprenorfina/uso terapêutico , Tratamento de Substituição de Opiáceos , Minnesota/epidemiologia , Estudos de Coortes , Estudos Retrospectivos , Padrões de Prática Médica , Transtornos Relacionados ao Uso de Opioides/diagnóstico por imagem , Atenção Primária à Saúde
11.
Am J Trop Med Hyg ; 107(5): 1041-1046, 2022 Nov 14.
Artigo em Inglês | MEDLINE | ID: mdl-36395745

RESUMO

Pretransplant recommendations advise risk-based screening for strongyloidiasis, schistosomiasis, and Chagas disease. We evaluated the implementation of a chronic parasite screening protocol at a health system in a nonendemic region serving a large foreign-born population. Candidates listed for kidney transplant at Hennepin Healthcare (Minneapolis, MN) between 2010 and 2020 were included. Country of birth and serologic screening for strongyloidiasis, schistosomiasis, and Chagas disease were retrospectively obtained from electronic medical records. Parasite screening frequency and seropositivity was assessed before and after implementation of a geographic risk factor-based screening protocol in 2014. Cost-efficiency of presumptive treatment was modeled. Of 907 kidney transplant candidates, 312 (34%) were born in the United States and 232 (26%) outside the United States, with the remainder missing country of birth information. The 447 (49%) candidates evaluated after implementation of the screening protocol had fewer unidentified countries of birth (53%-27%, P < 0.001) and were more frequently screened for strongyloidiasis, schistosomiasis, and Chagas disease (14%-44%, 8%-22%, and 1-14%, respectively, all Ps < 0.001). The number of identified seropositive candidates increased after protocol implementation from two to 14 for strongyloidiasis and from one to 11 for schistosomiasis, with none seropositive for Chagas disease. The cost-efficiency model favored presumptive ivermectin when strongyloidiasis prevalence reaches 30% of those screened. Implementing a geographic risk screening protocol before kidney transplant increases attention to infectious disease risk associated with country of birth and identification of chronic parasitic infections. In populations with higher strongyloidiasis prevalence or lower ivermectin costs, presumptive treatment may be cost-efficient.


Assuntos
Doença de Chagas , Transplante de Rim , Parasitos , Doenças Parasitárias , Esquistossomose , Estrongiloidíase , Animais , Humanos , Estados Unidos , Estrongiloidíase/diagnóstico , Estrongiloidíase/tratamento farmacológico , Estrongiloidíase/epidemiologia , Minnesota/epidemiologia , Ivermectina , Estudos Retrospectivos , Doenças Parasitárias/epidemiologia , Esquistossomose/epidemiologia , Doença de Chagas/diagnóstico , Doença de Chagas/epidemiologia
12.
Mayo Clin Proc ; 97(12): 2304-2313, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36344297

RESUMO

OBJECTIVE: To estimate the incidence of invasive pneumococcal disease (IPD) in the pre-13-valent pneumococcal conjugate vaccine (pre-PCV13; 7-valent pneumococcal conjugate vaccine era, 2002-2010) and post-PCV13 (2011-2018) time periods. PATIENTS AND METHODS: Using the Rochester Epidemiology Project, we conducted a population-based cohort study of all IPD cases in Olmsted County, Minnesota, from January 1, 2002, to December 31, 2018. RESULTS: Overall, 187 cases of IPD were identified. The incidence of IPD decreased significantly from 11.1 (95% CI, 9.1 to 13.2) to 5.6 (95% CI, 4.3 to 6.9) per 100,000 person-years when the pre- and post-PCV13 periods (2002-2010 vs 2011-2018) were compared (P<.001). Of the 187 patients with IPD, 112 (59.9%) had previously received at least 1 dose of pneumococcal vaccine. Among the IPD cases in the post-PCV13 period, there was an increase in non-PCV13 serotypes, mainly 11A (from 1.0% [1 of 105] to 6.2% [4 of 64]) and 33F (from 2.9% [3 of 105] to 15.6% [10 of 64]), while PCV13/non-7-valent pneumococcal conjugate vaccine serotypes declined from 38.1% (40 of 105) to 15.6% (10 of 64). At 30 days after an IPD diagnosis, the survival rate was 88.8% (95% CI, 84.4% to 93.4%). CONCLUSION: A marked decline in IPD incidence occurred during the post-PCV13 era. Because of the observed increase in non-PCV13 serotypes, coupled with multiple factors that impact the epidemiology of IPD, ongoing surveillance of patients with IPD, particularly due to non-PCV13 serotypes, is warranted.


Assuntos
Infecções Pneumocócicas , Vacinas Pneumocócicas , Humanos , Lactente , Vacinas Conjugadas , Estudos de Coortes , Minnesota/epidemiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Streptococcus pneumoniae , Vacinação , Incidência
13.
Mayo Clin Proc ; 97(10): 1836-1848, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36202495

RESUMO

OBJECTIVE: To describe smoking behaviors and pharmaceutical cessation aid uptake in a population-based Indigenous cohort compared with an age- and sex-matched non-Indigenous cohort. PATIENTS AND METHODS: Using the health record-linkage system of the Rochester Epidemiology Project (January 1, 2006, to December 31, 2019), smoking data of Indigenous residents of Olmsted County in Minnesota were abstracted to define the smoking prevalence, incidence, cessation, relapse after cessation, and pharmaceutical smoking cessation aid uptake compared with a matched non-Indigenous cohort. Prevalence was analyzed with a modified Poisson regression; cessation and relapse were evaluated with generalized estimating equations. Incidence was evaluated with a Cox proportional hazards model. RESULTS: Smoking prevalence was higher in the Indigenous cohort (39.0% to 47.0%; n=898) than the matched cohort (25.6% to 30.3%; n=1780). Pharmaceutical uptake was higher among the Indigenous cohort (35.8% of n=584 ever smokers vs 16.3% of n=778 ever smokers; P<.001). Smoking cessation events occurred more frequently in the Indigenous cohort (relative risk, 1.10; 95% CI, 1.06 to 1.13; P<.001). Indigenous former smokers were more likely to resume smoking (relative risk, 3.03; 95% CI, 2.93 to 3.14; P<.001) compared with the matched cohort. These findings were independent of socioeconomic status, age, and sex. CONCLUSION: Smoking in this Indigenous cohort was more prevalent compared with a sex- and age-matched non-Indigenous cohort despite more smoking cessation events and higher use of smoking cessation aids in the Indigenous cohort. The relapse rate after achieving cessation in the Indigenous cohort was more than three times higher than the non-Indigenous cohort. This finding has not been previously described and represents a potential target for relapse prevention efforts in US Indigenous populations.


Assuntos
Abandono do Hábito de Fumar , Fumar , Humanos , Minnesota/epidemiologia , Preparações Farmacêuticas , Recidiva , Fumar/epidemiologia
14.
World J Gastroenterol ; 28(35): 5217-5229, 2022 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-36188718

RESUMO

BACKGROUND: Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are known risk factors for liver disease, cirrhosis and hepatocellular carcinoma (HCC). There is substantial global variation in HBV and HCV prevalence resulting in variations in cirrhosis and HCC. We previously reported high prevalence of HBV and HCV infections in Somali immigrants seen at an academic medical center in Minnesota. AIM: To determine the prevalence of chronic viral hepatitis in Somali immigrants in Minnesota through a community-based screening program. METHODS: We conducted a prospective community-based participatory research study in the Somali community in Minnesota in partnership with community advisory boards, community clinics and local mosques between November 2010 and December 2015 (data was analyzed in 2020). Serum was tested for hepatitis B surface antigen, hepatitis B core antibody, hepatitis B surface antibody and anti-HCV antibody. RESULTS: Of 779 participants, 15.4% tested positive for chronic HBV infection, 50.2% for prior exposure to HBV and 7.6% for chronic HCV infection. Calculated age-adjusted frequencies in males and females for chronic HBV were 12.5% and 11.6%; for prior exposure to HBV were 44.8% and 41.3%; and for chronic HCV were 6.7% and 5.7%, respectively. Seven participants developed incident HCC during follow up. CONCLUSION: Chronic HBV and HCV are major risk factors for liver disease and HCC among Somali immigrants, with prevalence of both infections substantially higher than in the general United States population. Community-based screening is essential for identifying and providing health education and linkage to care for diagnosed patients.


Assuntos
Carcinoma Hepatocelular , Hepatite B Crônica , Hepatite B , Hepatite C Crônica , Hepatite C , Neoplasias Hepáticas , Carcinoma Hepatocelular/patologia , Feminino , Hepacivirus , Hepatite B/complicações , Anticorpos Anti-Hepatite B , Antígenos de Superfície da Hepatite B , Vírus da Hepatite B , Hepatite B Crônica/complicações , Hepatite B Crônica/epidemiologia , Hepatite C/complicações , Hepatite C Crônica/complicações , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/epidemiologia , Humanos , Incidência , Cirrose Hepática/complicações , Neoplasias Hepáticas/patologia , Masculino , Minnesota/epidemiologia , Prevalência , Estudos Prospectivos , Somália
15.
J Zoo Wildl Med ; 53(3): 578-582, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36214243

RESUMO

This article summarizes urinary stone submissions from foxes in human care to the Minnesota Urolith Center over 40 years. A previous report documented the analysis of uroliths from foxes that were submitted between 1981 and 2007.13 New data compiled from 2008 to 2021 included an additional 38 stones submitted from foxes, totaling 65 fox urolith submissions from 1981 to 2021. Struvite and cystine uroliths were most common, with the remainder comprised of calcium phosphate, calcium oxalate, compound, mixed, or miscellaneous material. Most stones were submitted from male foxes. Seventy-two percent of the stones were urocystoliths, and from 2010 to 2021, most stones were diagnosed antemortem and removed surgically. More than half of the stones were submitted from red foxes (Vulpes vulpes) and fennec foxes (Vulpes zerda). Urolithiasis in foxes may be an underrecognized condition, and data from this study suggest that clinicians should consider routine urinalysis and diagnostic imaging as part of the preventive medicine program for fox species, especially red foxes and fennec foxes.


Assuntos
Cálculos , Doenças do Cão , Cálculos Urinários , Urolitíase , Animais , Oxalato de Cálcio , Fosfatos de Cálcio/análise , Cálculos/veterinária , Cistina , Cães , Humanos , Compostos de Magnésio/análise , Masculino , Minnesota/epidemiologia , Fosfatos/análise , Estruvita , Cálculos Urinários/veterinária , Urolitíase/diagnóstico , Urolitíase/epidemiologia , Urolitíase/veterinária
16.
Parkinsonism Relat Disord ; 104: 64-67, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36244163

RESUMO

INTRODUCTION: Parkinson's disease (PD) most commonly surfaces at middle age. Earlier onset is characterized as Early-onset Parkinson's disease (EOPD), but the exact definition has been a matter of ongoing scientific debate. We investigated 40-year EOPD incidence trends in a population-based cohort of parkinsonism in Olmsted County, MN. METHODS: We used the Rochester Epidemiology Project (REP) to identify all incident EOPD cases in Olmsted County between 1976 and 2015. A movement-disorder specialist reviewed all cases to confirm the EOPD diagnosis. For EOPD definition, we used two age cut-offs: 50 and 55 years. RESULTS: EOPD incidence was 1.43/100,000 person-years for ≤55 and 0.55/100,000 for ≤50 years. Men had a higher incidence than women in both groups [1.84 vs 1.03 (p = 0.04); and 0.70 vs 0.40 (p = 0.24), respectively]. EOPD incidence diagnosed before age 55 increased each decade: from 1.02/100.000 person-year 1976-1985, to 1.32/100.000 person-year 2006-2015. A similar trend was observed when ≤50 years of age cut off was used (0.28/100,000 person-years 1976-1985, to 0.59/100,000 person-year 2006-2015). Incidence was consistently higher in men than women. Median time from EOPD-symptoms onset to death was shorter in the EOPD ≤55 group (21.9 years) compared to the EOPD ≤50 group (25.6 years). CONCLUSION: We observed an increased trend in the incidence of EOPD, both in ≤55 and ≤ 50 years of age. Overall, incidence of EOPD was 1.43 (≤55) and 0.55 (≤50) cases per 100,000 person-years, and although not significant, was higher in men than in women.


Assuntos
Doença de Parkinson , Transtornos Parkinsonianos , Pessoa de Meia-Idade , Masculino , Humanos , Feminino , Doença de Parkinson/epidemiologia , Doença de Parkinson/diagnóstico , Incidência , Idade de Início , Minnesota/epidemiologia
17.
Am J Prev Med ; 63(4): 505-512, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36137668

RESUMO

INTRODUCTION: Alcohol consumption, particularly excessive drinking, incurs a high societal cost. This study aimed to apply current state-specific data from 1 state, Minnesota, to established national methods for estimating the societal cost of excessive alcohol consumption for 2 purposes: first, to update the cost estimate for the state and, second, to understand the potential benefits of using state-specific data versus a national apportionment strategy for economic burden estimates. METHODS: In 2021, established methods were used to apply alcohol-attributable fractions for health care, lost productivity, crime, and other effects (e.g., motor vehicle crashes) to 2019 Minnesota data. The main outcome measure was the annual prevalence cost (incurred and paid each year) of excessive alcohol use in Minnesota from the societal perspective. Secondary outcome measures were the cost of specific outcomes (e.g., crime), different types of consumption (e.g., drinking during pregnancy), the cost to government payers, and the cost per drink. RESULTS: The societal cost of alcohol use in Minnesota in 2019 was nearly $8 billion dollars (2019 USD) or $1,383 per resident. This estimate is substantially higher than a previous estimate on the basis of apportionment of a national estimate. CONCLUSIONS: The cost of alcohol use in Minnesota is considerable. Geographically specific and current cost estimates can inform decision making about the public health impact of excessive alcohol use and the cost effectiveness of prevention strategies. Evidence-based prevention strategies to reduce alcohol use include increased alcohol taxes, enhanced enforcement of laws prohibiting sales to minors, and electronic screening and brief intervention.


Assuntos
Eficiência , Impostos , Consumo de Bebidas Alcoólicas/prevenção & controle , Análise Custo-Benefício , Custos de Cuidados de Saúde , Humanos , Minnesota/epidemiologia
19.
PLoS One ; 17(9): e0270615, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36166422

RESUMO

Given recent and abrupt declines in the abundance of moose (Alces alces) throughout parts of Minnesota and elsewhere in North America, accurately estimating statewide population trends and demographic parameters is a high priority for their continued management and conservation. Statistical population reconstruction using integrated population models provides a flexible framework for combining information from multiple studies to produce robust estimates of population abundance, recruitment, and survival. We used this framework to combine aerial survey data and survival data from telemetry studies to recreate trends and demographics of moose in northeastern Minnesota, USA, from 2005 to 2020. Statistical population reconstruction confirmed the sharp decline in abundance from an estimated 7,841 (90% CI = 6,702-8,933) in 2009 to 3,386 (90% CI = 2,681-4,243) animals in 2013, but also indicated that abundance has remained relatively stable since then, except for a slight decline to 3,163 (90% CI = 2,403-3,718) in 2020. Subsequent stochastic projection of the population from 2021 to 2030 suggests that this modest decline will continue for the next 10 years. Both annual adult survival and per-capita recruitment (number of calves that survived to 1 year per adult female alive during the previous year) decreased substantially in years 2005 and 2019, from 0.902 (SE = 0.043) to 0.689 (SE = 0.061) and from 0.386 (SE = 0.030) to 0.303 (SE = 0.051), respectively. Sensitivity analysis revealed that moose abundance was more sensitive to fluctuations in adult survival than recruitment; thus, we conclude that the steep decline in 2013 was driven primarily by decreasing adult survival. Our analysis demonstrates the potential utility of using statistical population reconstruction to monitor moose population trends and to identify population declines more quickly. Future studies should focus on providing better estimates of per-capita recruitment, using pregnancy rates and calf survival, which can then be incorporated into reconstruction models to help improve estimates of population change through time.


Assuntos
Cervos , Animais , Feminino , Minnesota/epidemiologia , América do Norte , Gravidez
20.
Am J Public Health ; 112(S7): S655-S657, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36179301

RESUMO

Lead exposure that occurs from contamination inadvertently brought home from a workplace is known as take-home exposure. Take-home exposures are a public health hazard that adversely affects health equity for families and communities. This article describes coordinated action by agencies in Minnesota to curb lead exposure among children of workers at a facility that produces fishing sinkers and battery terminals. (Am J Public Health. 2022;112(S7):S655-S657. https://doi.org/10.2105/AJPH.2022.306982).


Assuntos
Chumbo , Exposição Ocupacional , Criança , Humanos , Instalações Industriais e de Manufatura , Minnesota , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/prevenção & controle , Local de Trabalho
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