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1.
Sci Rep ; 11(1): 21368, 2021 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-34725394

RESUMO

There is a need for wastewater based epidemiological (WBE) methods that integrate multiple, variously sized surveillance sites across geographic areas. We developed a novel indexing method, Melvin's Index, that provides a normalized and standardized metric of wastewater pathogen load for qPCR assays that is resilient to surveillance site variation. To demonstrate the utility of Melvin's Index, we used qRT-PCR to measure SARS-CoV-2 genomic RNA levels in influent wastewater from 19 municipal wastewater treatment facilities (WWTF's) of varying sizes and served populations across the state of Minnesota during the Summer of 2020. SARS-CoV-2 RNA was detected at each WWTF during the 20-week sampling period at a mean concentration of 8.5 × 104 genome copies/L (range 3.2 × 102-1.2 × 109 genome copies/L). Lag analysis of trends in Melvin's Index values and clinical COVID-19 cases showed that increases in indexed wastewater SARS-CoV-2 levels precede new clinical cases by 15-17 days at the statewide level and by up to 25 days at the regional/county level. Melvin's Index is a reliable WBE method and can be applied to both WWTFs that serve a wide range of population sizes and to large regions that are served by multiple WWTFs.


Assuntos
COVID-19/epidemiologia , SARS-CoV-2/genética , População Suburbana , População Urbana , Instalações de Eliminação de Resíduos , Águas Residuárias/virologia , Vigilância Epidemiológica Baseada em Águas Residuárias , Purificação da Água , COVID-19/virologia , Genoma Viral , Humanos , Minnesota/epidemiologia , Prevalência , Prognóstico , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa/métodos , Fatores de Risco
2.
Am J Health Behav ; 45(5): 867-878, 2021 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-34702434

RESUMO

Objectives: Through focus groups, we aimed to understand ways to promote safe and healthy fish consumption among Hmong women in Minnesota. Methods: English-speaking Hmong women aged 18-40 were eligible to participate in 90-minute focus groups. Through our questions, we sought to gain understanding of the women's health-seeking behaviors and to obtain feedback on current messaging. We recorded the focus groups and transcribed and double-coded the data using sequential directed content analysis. Results: Thirteen Hmong women participated across 3 focus groups. The final coding tree included 6 primary themes related to health messaging, with adequate inter-coder reliability for each. Women identified the Internet as the primary source of health information with website preferences driven in-part by preferences of elders. Discrepancies between health beliefs of elder and younger generations were noted, with some evidence that personal fish consumption preferences outweighed cultural norms. Messages clearly targeting the Hmong population were preferred, with discrepancy in risk-versus benefit-framed messages. Conclusions: Findings highlight the need for culturally informed messages that are clear and carefully tailored. Our findings will inform future development of safe and healthy fish consumption messaging to better support the Hmong community in Minnesota.


Assuntos
Comportamentos Relacionados com a Saúde , Idoso , Animais , Feminino , Grupos Focais , Humanos , Minnesota , Reprodutibilidade dos Testes
3.
BMC Public Health ; 21(1): 1915, 2021 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-34674674

RESUMO

PURPOSE: Despite public health efforts to reduce childhood obesity, there remains an unequal distribution of obesity among rural and urban children, with higher rates in rural areas. However, few studies have compared differences in program delivery. This paper aims to describe differences between an urban and rural program delivery of a family-focused, community-based intervention program to prevent and reduce obesity among children. METHODS: This paper uses a case study format to provide a descriptive analysis of similar obesity prevention programs, designed by the same research team, implemented in Minnesota in different settings (i.e., an urban and rural setting) with significant community engagement in the adaptation process. The rural NU-HOME program is compared to HOME-Plus, an urban family-based obesity prevention program for school-aged children. RESULTS: Community engagement in the adaptation process of an urban program to a rural program confirmed some anticipated program content and delivery similarities while identifying key differences that were necessary for adaptation related to engagement with the community, recruitment and data collection, and intervention delivery. DISCUSSION: When adapting research-tested programs from urban to rural areas, it is important to identify the modifiable behavioral, social, and environmental factors associated with obesity to ensure the content of effective childhood obesity prevention programs is relevant. Customizing a program to meet the needs of the community may increase reach, engagement, and sustainability. In addition, long-term dissemination of a tailored program may significantly reduce childhood obesity in rural communities and be implemented in other rural settings nationally.


Assuntos
Obesidade Pediátrica , População Rural , Criança , Humanos , Minnesota , Obesidade Pediátrica/prevenção & controle
4.
Am Surg ; 87(9): 1374-1378, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34468234

RESUMO

BACKGROUND: Until 2015, standard of care for low-risk papillary thyroid cancer (PTC) >1 cm was a total or near-total thyroidectomy. Despite changes in guidelines and surgical management of low-risk PTC since 2015, little data are available regarding the effect on the need for additional surgery or risk for development of lymph node metastases. Our aim was to determine outcomes in patients who underwent initial thyroid lobectomy for low-risk PTC at a high-volume tertiary care institution. METHODS: Retrospective review of patients ≥18 years old with biopsy proven low-risk PTC 1-4 cm who underwent partial thyroidectomy (eg, lobectomy/isthmusectomy) at Mayo Clinic, Rochester, MN, between March 2016 and June 30, 2019. RESULTS: From 1481 thyroidectomies performed during study period, 940 contained PTC on final pathology. Of these, 87 (of 123) patients who had an initial thyroid lobectomy met inclusion criteria. Five (6%) of these patients proceeded to completion thyroidectomy (CT), with 3 requiring CT and radioactive iodine in the first postoperative year and 2 undergoing only CT in the second postoperative year. No postoperative complications were reported. No patient in this cohort required additional surgery or treatment for newly discovered lymph node metastases during the follow-up period. 43 (of 72, 60%) patients not on thyroxine therapy preoperatively were started on thyroxine therapy postoperatively. CONCLUSIONS: Early outcomes for those undergoing thyroid lobectomy for low-risk PTC at our institution have been favorable. These results support the 2015 American Thyroid Association guidelines to offer lobectomy for those with low-risk PTC 1-4 cm.


Assuntos
Câncer Papilífero da Tireoide/cirurgia , Tireoidectomia/métodos , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Minnesota , Estudos Retrospectivos , Fatores de Risco , Câncer Papilífero da Tireoide/radioterapia
5.
Int Psychogeriatr ; 33(10): 1105-1109, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34551841

RESUMO

Delirium is reported to be one of the manifestations of coronavirus infectious disease 2019 (COVID-19) infection. COVID-19 hospitalized patients are at a higher risk of delirium. Pathophysiology behind the association of delirium and COVID-19 is uncertain. We analyzed the association of delirium occurrence with outcomes in hospitalized COVID-19 patients, across all age groups, at Mayo Clinic hospitals.A retrospective study of all hospitalized COVID-19 patients at Mayo Clinic between March 1, 2020 and December 31, 2020 was performed. Occurrence of delirium and outcomes of mortality, length of stay, readmission, and 30-day mortality after hospital discharge were measured. Chi-square test, student t-test, survival analysis, and logistic regression analysis were performed to measure and compare outcomes of delirium group adjusted for age, sex, Charlson comorbidity score, and COVID-19 severity with no-delirium group.A total of 4351 COVID-19 patients were included in the study. Delirium occurrence in the overall study population was noted to be 22.4%. The highest occurrence of delirium was also noted in patients with critical COVID-19 illness severity. A statistically significant OR 4.35 (3.27-5.83) for in-hospital mortality and an OR 4.54 (3.25-6.38) for 30-day mortality after discharge in the delirium group were noted. Increased hospital length of stay, 30-day readmission, and need for skilled nursing facility on discharge were noted in the delirium group. Delirium in hospitalized COVID-19 patients is a marker for increased mortality and morbidity. In this group, outcomes appear to be much worse when patients are older and have a critical severity of COVID-19 illness.


Assuntos
COVID-19/mortalidade , Delírio/epidemiologia , Hospitalização/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/complicações , Criança , Pré-Escolar , Delírio/complicações , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Estudos Retrospectivos , SARS-CoV-2 , Adulto Jovem
6.
BMJ Open ; 11(9): e047930, 2021 09 02.
Artigo em Inglês | MEDLINE | ID: mdl-34475163

RESUMO

OBJECTIVES: To estimate the health characteristics and racial/ethnic health disparities among a probation cohort in Hennepin County. We hypothesised the probation population would have higher health needs compared with the general population as well as significant racial/ethnic health disparities. DESIGN: Cross-sectional study using linked administrative records. PARTICIPANTS: Of 7992 eligible individuals, 5873 met inclusion criteria of 6 or more months of eligibility for a full-benefit Minnesota healthcare plan. SETTING: Probation system in Hennepin County in 2016. OUTCOMES: We compared health condition prevalence among our probation cohort with survey data from the general population and analysed by race/ethnicity. We also measured sociodemographic characteristics, including the use of safety-net services. RESULTS: Individuals were predominantly male (80.5%), young (mean age: 35.5 years), and disproportionately black or African American (52.9%). A majority of individuals enrolled in Medicaid were eligible via Medicaid expansion (65.9%). Compared with the general population, individuals on probation had higher rates of substance use disorders (66.5% vs 8.1%), mental illness (55.3% vs 14.4%) and many physical conditions (eg, asthma: 17.0% vs 12.5%, chronic kidney disease: 5.8% vs 0.2%). White individuals on probation were significantly more likely than black or African American individuals to have a diagnosed substance use disorder (71.6% vs 62.0%) or mental health disorder (64.9% vs 48.5%), but fewer chronic physical health conditions (average: 0.52 vs 0.73 chronic physical conditions). CONCLUSIONS: Individuals on probation have high health needs, which vary substantially by race/ethnicity. Without attention to this variation, interventions to address health conditions in this population could worsen racial/ethnic disparities.


Assuntos
Grupo com Ancestrais do Continente Europeu , Hispano-Americanos , Adulto , Afro-Americanos , Estudos Transversais , Grupos Étnicos , Disparidades em Assistência à Saúde , Humanos , Masculino , Minnesota/epidemiologia , Estados Unidos
7.
J Am Board Fam Med ; 34(5): 1055-1065, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34535536

RESUMO

BACKGROUND: The Department of Family Medicine and Community Health at the University of Minnesota engaged in a 5-year transformation to expand research and scholarship opportunities to all faculty. A harmonization framework was used to integrate the 3 missions of clinical care, education, and research to ensure that research and scholarship were an ongoing focus of the department. METHODS: The key elements of our transformation included as follows: (1) a general culture of inquiry, (2) harmonized leadership, (3) training and mentoring, and (4) infrastructure and resources. Components of each of these elements were intentionally instituted simultaneously and iteratively across the 5 years to provide robust and sustainable research and scholarship opportunities for all faculty. RESULTS: Outputs and outcomes of the harmonized transformation indicated that clinical and research faculty publications increased, and the percentage of clinical faculty trained in research and scholarship skills increased across the 5 years. CONCLUSIONS: Important lessons learned during the harmonized transformation included the following: (1) key elements of the transformation need to be balanced as an ensemble, (2) cultural and organizational shifts take concerted effort and time, (3) embrace iteration: allow "bumps in the road" to propel the work forward, (4) transformation is financially feasible, (5) career research faculty can mutually benefit from clinical faculty engaging in scholarship, and (6) honor skepticism or disinterest and let people cultivate enthusiasm for research and scholarship rather than being forced.


Assuntos
Medicina de Família e Comunidade , Bolsas de Estudo , Docentes de Medicina , Humanos , Liderança , Minnesota
8.
Health Aff (Millwood) ; 40(10): 1644-1653, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34524913

RESUMO

Substantial racial and ethnic disparities in COVID-19 mortality have been observed at the state and national levels. However, less is known about how race and ethnicity and neighborhood-level disadvantage may intersect to contribute to both COVID-19 mortality and excess mortality during the pandemic. To assess this potential interaction of race and ethnicity with neighborhood disadvantage, we link death certificate data from Minnesota from the period 2017-20 to the Area Deprivation Index to examine hyperlocal disparities in mortality. Black, Indigenous, and people of color (BIPOC) standardized COVID-19 mortality was 459 deaths per 100,000 population in the most disadvantaged neighborhoods compared with 126 per 100,000 in the most advantaged. Total mortality increased in 2020 by 14 percent for non-Hispanic White people and 41 percent for BIPOC. Statistical decompositions show that most of this growth in racial and ethnic disparity is associated with mortality gaps between White people and communities of color within the same levels of area disadvantage, rather than with the fact that White people live in more advantaged areas. Policy interventions to reduce COVID-19 mortality must consider neighborhood context.


Assuntos
COVID-19 , Grupos Étnicos , Humanos , Minnesota/epidemiologia , SARS-CoV-2
9.
J Affect Disord ; 295: 771-780, 2021 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-34517251

RESUMO

BACKGROUND: Previous COVID-19 pandemic research has focused on assessing the severity of psychological responses to pandemic-related stressors. Little is understood about (a) resilience as a mental health protective factor during these stressors, and (b) whether families from Eastern and Western cultures cope differently. This study examines how individual resilience and family resilience moderate the associations between pandemic-related stressors and symptoms of depression, anxiety, and stress in two culturally distinct regions. METHODS: A total of 1,039 adults (442 from Minnesota, United States, and 597 from Hong Kong) living with at least one family member completed an online survey about COVID-19-related experiences, mental health, individual resilience and family resilience from May 20 to June 30, 2020. Predictors of depression, anxiety, and stress symptoms were examined separately using hierarchical regression analyses. RESULTS: In both regions, pandemic-related stressors predicted higher symptoms of depression, anxiety, and stress. Individual resilience and two domains of family resilience were associated with positive mental health. In Minnesota, higher levels of individual resilience buffered the negative relationship between pandemic-related stressors and depressive symptoms; higher levels of family communication and problem solving also buffered the negative relationship between pandemic-related stressors and stress symptoms. In Hong Kong, higher family-level positive outlook magnified the negative relationship between pandemic-related stressors and anxiety symptoms. CONCLUSIONS: Individual and family resilience is protective against the adverse psychological effects of pandemic stressors, but they vary across cultures and as exposure to pandemic-related stressors increases.


Assuntos
COVID-19 , Resiliência Psicológica , Adulto , Depressão/epidemiologia , Saúde da Família , Hong Kong/epidemiologia , Humanos , Saúde Mental , Minnesota/epidemiologia , Pandemias , SARS-CoV-2 , Estados Unidos
10.
J Healthc Manag ; 66(5): 380-394, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34495002

RESUMO

EXECUTIVE SUMMARY: The article examines whether subjective performance assessments from health system executives match objective performance assessments and qualitatively explores ways to achieve high performance. We interviewed 138 C-suite executives of 24 health systems in California, Minnesota, Washington, and Wisconsin between 2017 and 2019. We used maximum variation sampling to select health systems to achieve diversity in performance on objective measures of clinical performance. Our interviews focused on executives' perceptions of their own health system's performance and factors they thought generally contributed to high performance. In our analysis, we grouped health systems based on objective performance levels (high, medium, and low) used in sampling, compared objective performance ratings with executives' subjective performance assessments, and used thematic analysis to identify reasons for subjective assessment of health system performance and levers of high performance in general. There was poor agreement between objective and subjective performance assessments (kappa = 0.082). Subjective assessments were higher than objective assessments and captured more factors than are typically considered in performance accountability and value-based payment initiatives. Executives whose views were inconsistent with objective performance assessments did not cite clinical care quality per se as the basis for their assessment, focusing instead on market competition, financial performance, and high customer satisfaction and loyalty. Executives who cited clinical quality metrics as the basis of their assessment offered subjective ratings consistent with objective ratings. Executives identified organizational culture, organizational governance, and staff engagement as levers for achieving high performance. Future research should explore the benefits and drawbacks of considering subjective performance assessments in value-based payment initiatives.


Assuntos
Cultura Organizacional , Qualidade da Assistência à Saúde , Humanos , Minnesota , Washington , Wisconsin
11.
PLoS One ; 16(8): e0255348, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34403414

RESUMO

Educational success is associated with greater quality of life and depends, in part, on heritable cognitive and non-cognitive traits. We used polygenic scores (PGS) for smoking and educational attainment to examine different genetic influences on facets of academic adjustment in adolescence and educational attainment in adulthood. PGSs were calculated for participants of the Minnesota Twin Family Study (N = 3225) and included as predictors of grades, academic motivation, and discipline problems at ages 11, 14, and 17 years-old, cigarettes per day from ages 14 to 24 years old, and educational attainment in adulthood (mean age 29.4 years). Smoking and educational attainment PGSs had significant incremental associations with each academic variable and cigarettes per day. About half of the adjusted effects of the smoking and education PGSs on educational attainment in adulthood were mediated by the academic variables in adolescence. Cigarettes per day from ages 14 to 24 years old did not account for the effect of the smoking PGS on educational attainment, suggesting the smoking PGS indexes genetic influences related to general behavioral disinhibition. In sum, distinct genetic influences measured by the smoking and educational attainment PGSs contribute to academic adjustment in adolescence and educational attainment in adulthood.


Assuntos
Escolaridade , Herança Multifatorial , Fumar/genética , Gêmeos/educação , Sucesso Acadêmico , Adolescente , Adulto , Criança , Feminino , Estudos de Associação Genética , Humanos , Estudos Longitudinais , Masculino , Minnesota , Fumar/epidemiologia , Produtos do Tabaco/estatística & dados numéricos , Gêmeos/genética , Adulto Jovem
12.
J Health Care Poor Underserved ; 32(3): 1096-1101, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34421014

RESUMO

Psychologists housed in two family medicine residency clinics located in underserved communities quickly transitioned their mode of psychotherapy from in-person to completely virtual at the beginning of the COVID-19 pandemic. We share numerous successes and advantages of a telehealth model in serving our community and describe challenges we have encountered.


Assuntos
Controle de Doenças Transmissíveis , Área Carente de Assistência Médica , Psicoterapia , Telemedicina , Terapia Comportamental , COVID-19/epidemiologia , COVID-19/prevenção & controle , Humanos , Minnesota/epidemiologia , Pandemias , Comunicação por Videoconferência
13.
Avian Dis ; 65(1): 52-58, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34339122

RESUMO

A flock of captive bobwhite quail (Colinus virginianus) experienced loose droppings, depression, and increased mortality starting at 3 wk of age. Necropsy of the affected birds revealed intestines dilated with frothy and tan fluid. Irregular dark brown fissures within the koilin layer of the gizzard were found in 20%-30% of the birds. Histologically, gizzards showed multifocal koilin degeneration or fragmentation, degeneration and necrosis of the subjacent epithelial cells, and infiltration of macrophages, lymphocytes, and heterophils. Necrotic epithelial cells occasionally contained large, smudgy, basophilic intranuclear inclusion bodies with marginated nuclear chromatin. Adenoviral paracrystalline arrays composed of icosahedral virions (60-70 nm diameter) were seen on transmission electron microscopy in the nuclei of epithelial cells in the gizzard mucosa. Adenovirus was isolated from gizzard, liver, intestine, and trachea by inoculation of specific-pathogen-free embryonated chicken eggs. Homogenates of the gizzard, liver, and intestine were positive for the adenovirus hexon gene by PCR. Sequencing of PCR amplicons confirmed the virus as fowl aviadenovirus A. The study isolates showed more than 99% and 97% nucleotide identity with quail bronchitis virus and with aviadenoviruses from gizzard erosion and ulceration (GEU) in broilers, respectively. The viral isolates showed six substitutions (G1T, C174A, A229G, C513A, T579A, and G621C) of which two were nonsynonymous (G1T and A229G), resulting in a change in the translated amino acid as A1S and S77G, respectively. These results indicate that adenoviruses of the same type or species can cause different clinical presentations in quails, e.g., bronchitis or GEU.


Assuntos
Infecções por Adenoviridae/veterinária , Aviadenovirus/fisiologia , Colinus , Doenças das Aves Domésticas/epidemiologia , Úlcera Gástrica/veterinária , Infecções por Adenoviridae/epidemiologia , Infecções por Adenoviridae/patologia , Infecções por Adenoviridae/virologia , Animais , Moela das Aves/patologia , Minnesota/epidemiologia , Úlcera Péptica , Doenças das Aves Domésticas/patologia , Doenças das Aves Domésticas/virologia , Úlcera Gástrica/epidemiologia , Úlcera Gástrica/patologia , Úlcera Gástrica/virologia
14.
Avian Dis ; 65(1): 63-66, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-34339124

RESUMO

Minnesota is the leading state in number of turkeys produced in the United States. Turkey flocks in the field are usually vaccinated several times with live avian orthoavulavirus 1 (AOAV-1) vaccines starting as early as 2 wk of age (WOA). During the years 2018-2019, many turkey flocks were diagnosed with low-virulence AOAV-1 infection around 9 WOA that led to respiratory disease, although they were previously vaccinated. This study was designed to investigate the immunity against AOAV-1 in Minnesota turkey flocks in the field and experimentally after vaccination. We reviewed antibody titers against AOAV-1 from turkey flocks tested by ELISA at Minnesota Poultry Testing Laboratory (n = 1292). Up to 9 WOA, more than 85% of the field flocks tested had unprotective antibody titers against AOAV-1. However, commercial poults at 3 WOA experimentally vaccinated by eye-drop method had an ELISA geometric mean titer of 6011 at 7 WOA. Oropharyngeal virus shedding after vaccination was 10%, 70%, 80%, and 40% at 1, 3, 5, and 7 days postvaccination, respectively. This study demonstrates that experimentally vaccinated turkeys respond very well to AOAV-1 vaccine when properly administered. However, there is clear vaccination failure in the field, where vaccine is commonly administered in drinking water, a method that is more susceptible to failure because of many variables in this procedure. We recommend choosing the most effective method of vaccine administration. Given the high incidence of inadequate immunity induced in commercial turkeys on mass application of live AOAV-1 vaccines in water, alternative application methods and subsequent monitoring of the serologic antibody response must be undertaken to ensure a proper immune response.


Assuntos
Infecções por Avulavirus/veterinária , Avulavirus/efeitos dos fármacos , Doenças das Aves Domésticas/prevenção & controle , Falha de Tratamento , Perus , Vacinação/veterinária , Vacinas Virais/administração & dosagem , Animais , Infecções por Avulavirus/prevenção & controle , Infecções por Avulavirus/virologia , Minnesota , Doenças das Aves Domésticas/virologia
15.
J Am Mosq Control Assoc ; 37(3): 125-131, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34407168

RESUMO

Larvicides that contain spinosad, a bacterial metabolite, are used to control mosquitoes in diverse aquatic habitats. These same habitats are home to other invertebrates, including Crustacea-fairy shrimp, isopods, and amphipods-and mollusks-fingernail clams and freshwater snails. A double-blind study evaluated the effects of Natular® G, a granular treatment containing spinosad, on spring Aedes spp. and nontarget invertebrates in vernal wetlands. Within 14 days after application, Natular G controlled larvae of spring Aedes by 53-84%, depending on species, but had no significant effects on numbers of fairy shrimp, fingernail clams, or freshwater snails. A second double-blind study evaluated effects on Coquillettidia perturbans and nontarget isopods and amphipods in cattail marshes. Treatment reduced emergence of Cq. perturbans by 25% but did not change numbers of isopods or amphipods. The 2 experiments indicate Natular G could be effective against spring Aedes in vernal wetlands, less so against Cq. perturbans in cattail marshes, and yet pose minimal risk to crustaceans and mollusks in either vernal wetlands or cattail marshes.


Assuntos
Aedes , Inseticidas , Typhaceae , Animais , Método Duplo-Cego , Combinação de Medicamentos , Larva , Macrolídeos , Minnesota , Controle de Mosquitos , Áreas Alagadas
16.
J Am Dent Assoc ; 152(10): 813-821, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34392938

RESUMO

BACKGROUND: Expansion of the dental team may play a role in increasing access to oral health care. In 2009, Minnesota became the first state to formally license dental therapists (DTs). METHODS: The authors surveyed DTs and advanced dental therapists (ADTs) in Minnesota to gain a better understanding of those who enter the profession and their motivation for doing so, as well as to solicit their opinions on the overall structure of dental therapy education and the regulatory aspects of the profession. RESULTS: The response rate was 53.1%. DTs and ADTs were split on whether a dental hygiene degree should be required. Primary reasons for entering dental therapy included more autonomy and a larger scope of practice. Respondents expressed a desire for broadened prescribing rights. The median annual income was in the $81,000 through $90,000 bracket. CONCLUSIONS: Minnesota DTs and ADTs must practice in underserved communities. However, their ability to expand access to oral health care is affected by their licensure requirement, scope of practice, and prescription rights. PRACTICAL IMPLICATIONS: Policy makers considering dental therapy legislation must consider educational requirements and scope of practice when crafting state legislation. Broadening the scope of practice may allow for more impactful care for at-risk communities.


Assuntos
Acesso aos Serviços de Saúde , Saúde Bucal , Assistência Odontológica , Humanos , Minnesota , Motivação , Inquéritos e Questionários
17.
PLoS One ; 16(8): e0255466, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34383817

RESUMO

OBJECTIVES: To assess the interobserver agreement in categories of electrocardiogram (ECG) abnormalities using the Minnesota Code criteria. METHODS: We used a random sample of 180 ECGs from people with type 2 diabetes. ECG abnormalities were classified and coded using the Minnesota ECG Classification. Each ECG was independently rated on several abnormalities by an experienced rater (rater 1) and by two cardiologists (raters 2 and 3) trained to apply the Minnesota codes on four Minnesota codes; 1-codes as an indication for myocardial infarction, 4 en 5-codes as an indication for ischemic abnormalities, 3-codes as an indication for left ventricle hypertrophy, 7-1-codes as an indication for ventricular conduction abnormalities, and 8-3-codes as an indication for atrial fibrillation / atrial flutter. After all pairwise tables were summed, the overall agreement, the specific positive and negative agreement were calculated with a 95% confidence interval (CI) for each abnormality. Also, Kappa's with a 95% CI were calculated. RESULTS: The overall agreement (with 95% CI) were for myocardial infarction, ischemic abnormalities, left ventricle hypertrophy, conduction abnormalities and atrial fibrillation/atrial flutter respectively: 0.87 (0.84-0.91), 0.79 (0.74-0.84), 0.81 (0.76-0.85), 0.93 (0.90-0.95), 0.96 (0.93-0.97). CONCLUSION: This study shows that the overall agreement of the Minnesota code is good to excellent.


Assuntos
Diabetes Mellitus Tipo 2 , Fibrilação Atrial , Eletrocardiografia , Frequência Cardíaca , Ventrículos do Coração , Humanos , Hipertrofia Ventricular Esquerda , Masculino , Pessoa de Meia-Idade , Minnesota , Infarto do Miocárdio , Variações Dependentes do Observador , Fatores de Risco
18.
AANA J ; 89(4): 299-306, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34342567

RESUMO

Prior research suggests general anesthesia (GA) with remifentanil is superior to GA without remifentanil regarding perioperative outcomes, including the postanesthesia care unit (PACU) length of stay (LOS). The objective of this study was to compare the intraoperative management and PACU LOS in patients who underwent GA with or without remifentanil for bronchoscopy. The study included 5,763 adult patients who underwent flexible bronchoscopy and received GA with or without remifentanil or who underwent rigid bronchoscopy and received GA with or without remifentanil. Despite prolonged procedural length in both the flexible and rigid bronchoscopy groups and greater ASA score in the flexible bronchoscopy group, no difference in the adjusted PACU LOS or time to extubation was found. Remifentanil was associated with hemodynamic perturbations and desaturation events. Remifentanil was associated with a significant reduction in nonremifentanil opioid requirements. Although both groups receiving remifentanil were associated with a less favorable intraoperative hemodynamic profile, remifentanil did not increase the incidence of postoperative complications despite that group having a greater ASA score and procedural duration.


Assuntos
Analgésicos Opioides/administração & dosagem , Anestesia Geral/normas , Anestésicos Intravenosos/normas , Broncoscopia/métodos , Broncoscopia/normas , Guias de Prática Clínica como Assunto , Remifentanil/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Minnesota , Estudos Retrospectivos
19.
Am Heart J ; 241: 59-67, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34293294

RESUMO

INTRODUCTION: While severe hyperkalemia is commonly encountered, its manifestation in hospitalized patients and related outcomes are unclear. We aimed to examine development of hyperkalemia in hospitalized patients and associated outcomes. METHODS: Data from a county hospital electronic health record were used to assess all inpatient admissions, 2012-2016, for non-dialysis-dependent patients with ≥1 K value for development of hyperkalemia. Unadjusted odds ratios (ORs) were calculated for associations of the maximum K value with in-hospital mortality and adjusted ORs were calculated for death associated with hyperkalemia. RESULTS: In 47,018 individual patient hospitalizations, 1.3% had a maximum K ≥6.0 mEq/L and 4.2% <3.5 mEq/L. Fifth and 95th percentiles for maximum K values were 3.5 and 5.3 mEq/L. For high-K patients with a prior K value, the mean (SD) of the immediate pre-maximum K value was 5.0 ± 1.0 mEq/L, and the mean difference in K values (immediate pre-maximum to maximum) was 1.5 ± 1.1 mEq/L; mean duration between these two K tests was 10.7 ± 14.9 hours. Compared with maximum K values 3.5 to 4.0 mEq/L, ORs for death were 37.1 (95% confidence intervals, 25.8-53.3) for K 6.0 to <6.5, 88.6 (56.8-138.2) for K ≥7.0, and 18.9 (4.3-82.2) for K <3.0 mEq/L. In adjusted models, the OR for death for K ≥6.0 mEq/L was 4.9 (3.7-6.4). DISCUSSION/CONCLUSIONS: Peak K values ≥6.0 mEq/L were associated with mortality. Values tended to increase rapidly, limiting opportunities for detection and treatment. Systems-based approaches to detect life-threatening hyperkalemia should be studied.


Assuntos
Hospitalização/estatística & dados numéricos , Hiperpotassemia , Potássio/sangue , Biomarcadores/análise , Biomarcadores/sangue , Causas de Morte , Diagnóstico Precoce , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Mortalidade Hospitalar , Humanos , Hiperpotassemia/sangue , Hiperpotassemia/diagnóstico , Hiperpotassemia/mortalidade , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Minnesota/epidemiologia , Potássio/análise , Melhoria de Qualidade , Estudos Retrospectivos , Risco Ajustado/métodos , Tempo para o Tratamento
20.
J Acad Nutr Diet ; 121(9): 1679-1694, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34294591

RESUMO

BACKGROUND: A steep rise in food insecurity is among the most pressing US public health problems that has resulted from the COVID-19 pandemic. OBJECTIVE: This study aimed to (1) describe how food-insecure emerging adults are adapting their eating and child-feeding behaviors during COVID-19 and (2) identify barriers and opportunities to improve local food access and access to food assistance. DESIGN: The COVID-19 Eating and Activity Over Time study collected survey data from emerging adults during April to October 2020 and completed interviews with a diverse subset of food-insecure respondents. PARTICIPANTS/SETTING: A total of 720 emerging adults (mean age: 24.7 ± 2.0 years; 62% female; 90% living in Minnesota) completed an online survey, and a predominately female subsample (n = 33) completed an interview by telephone or videoconference. MAIN OUTCOME MEASURES: Survey measures included the short-form of the US Household Food Security Survey Module and 2 items to assess food insufficiency. Interviews assessed eating and feeding behaviors along with barriers to healthy food access. ANALYSES PERFORMED: Descriptive statistics and a hybrid deductive and inductive content analysis. RESULTS: Nearly one-third of survey respondents had experienced food insecurity in the past year. Interviews with food-insecure participants identified 6 themes with regard to changes in eating and feeding behavior (eg, more processed food, sporadic eating), 5 themes regarding local food access barriers (eg, limited enforcement of COVID-19 safety practices, experiencing discrimination), and 4 themes regarding barriers to accessing food assistance (eg, lack of eligibility, difficulty in locating pantries). Identified recommendations include (1) expanding the distribution of information about food pantries and meal distribution sites, and (2) increasing fresh fruit and vegetable offerings at these sites. CONCLUSIONS: Interventions of specific relevance to COVID-19 (eg, stronger implementation of safety practices) and expanded food assistance services are needed to improve the accessibility of healthy food for emerging adults.


Assuntos
COVID-19/epidemiologia , Dieta/normas , Assistência Alimentar/normas , Insegurança Alimentar , Adulto , Grupos Étnicos , Comportamento Alimentar , Feminino , Humanos , Masculino , Minnesota/epidemiologia , Prevalência , Racismo/etnologia , SARS-CoV-2 , Discriminação Social/etnologia , Fatores Socioeconômicos , Adulto Jovem
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