Minnesota health department. Epidemic shigellosis in Minnesota 1973.
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Adolescent↗
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Medical revolution in Minnesota: a history of the University of Minnesota Medical School.
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History, 19th Century↗
Crystallization of R-form lipopolysaccharides from Salmonella minnesota and Escherichia coli.
Salmonella minnesota Re and Ra lipopolysaccharides (LPSs) and Escherichia coli K-12 LPS formed three-dimensional crystals, either hexagonal plates (preferential growth along the a axis) or solid columns (preferential growth along the c axis), when they were precipitated by the addition of 2 volumes of 95% ethanol containing 375 mM MgCl2 and incubated in 70% ethanol containing 250 mM MgCl2 at 4 degrees C for 10 days. Analyses of crystals suggested that they consist of hexagonal lattices with the a axis (a side of the lozenge as a unit cell on the basal plane) of 0.462 nm for all these three kinds of LPSs and the c axes (perpendicular to the basal plane) of 5.85, 8.47, and 8.75 nm for S. minnesota Re and Ra LPSs and E. coli K-12 LPS, respectively, and that hydrocarbon chains of the lipid A portion play the leading part in crystallization, whereas the hydrophilic part of the lipid A (the disaccharide backbone) and R core exhibit a disordered structure or are in a random orientation. The phenomenon of doubling of the a axis to 0.924 nm was observed with crystals of S. minnesota Re LPS when they were incubated in 70% ethanol for an additional 180 days, but not with crystals of S. minnesota Ra LPS or E. coli K-12 LPS. S. minnesota S-form LPS possessing the O-antigen-specific polysaccharide and S. minnesota free lipid A obtained by acid hydrolysis of Re LPS did not crystallize under the same experimental conditions.
Carbohydrate Conformation↗
The impact of experience with AIDS on HIV testing and counseling practices: a study of U.S. infectious disease teaching hospitals and Minnesota hospitals.
A survey on HIV antibody testing practices was sent to the 200 hospitals in the United States that conduct infectious disease (ID) fellowship training and to all 171 short-term care Minnesota hospitals. Responses were obtained from 124 U.S. ID hospitals (62%) and from 133 (78%) Minnesota hospitals. The U.S. ID hospitals estimated that consent for HIV antibody testing is obtained 70.1% of the time, that consent is both obtained and documented 54.3% of the time, and that risk-reduction counseling in conjunction with such testing is provided 51.4% of the time. The Minnesota hospitals estimated that consent for HIV antibody testing is obtained 35.2% of the time, that consent is both obtained and documented 25.7% of the time, and that risk-reduction counseling in conjunction with such testing is provided 21.8% of the time. Wide variance was noted in both the U.S. and Minnesota responses. Those U.S. hospitals serving higher numbers of persons with AIDS gave higher estimates for each of the 3 items (p less than .05); similar findings were noted among the Minnesota hospitals. The data suggests that standard clinical use of HIV testing remains deficient.
AIDS Serodiagnosis↗
Invasive Haemophilus influenzae type b disease in children less than 5 years of age in Minnesota and in Dallas County, Texas, 1983-1984.
During 1983 and 1984, 733 cases of invasive Haemophilus influenzae type b disease in children less than 5 years of age were identified in Minnesota and in Dallas County, Texas. The overall incidence of disease was lower in Minnesota than in Dallas County. However, among urban residents, the rates of disease for whites were similar in the two areas. A higher rate of disease among whites in urban Minnesota compared with rural Minnesota resulted from an increased rate of cases for diagnoses other than meningitis. Local practices might have affected the rate of certain diagnoses, since ascertainment of Hib disease other than meningitis is more dependent on diagnostic practices than is diagnosis of meningitis. These data suggest that the incidence of invasive H. influenzae type b disease is influenced by the racial composition of the population, the rates of disease in specific subgroups, and possibly by local medical practices. Understanding the factors that contribute to the incidence of disease is necessary to interpret variations in different populations and changes over time.
Age Factors↗
Methicillin-resistant Staphylococcus aureus in Minnesota nursing homes.
OBJECTIVE: To assess the experience of Minnesota nursing homes with methicillin-resistant Staphylococcus aureus (MRSA) and the policies and procedures used for its control. DESIGN: A 12-question survey, with primarily categorical responses, was mailed to the Directors of Nursing of all Minnesota long-term-care facilities. A follow-up mailing was sent to non-responders 5 weeks later. The mailing included a cover letter, a description of the study and its purposes, and a stamped return envelope. Four weeks after the second mailing, all non-responding institutions were contacted by telephone and invited to participated by mail or by completing the survey by telephone. SETTING: All long-term-care facilities in Minnesota licensed for skilled and intermediate care. PARTICIPANTS: The survey was directed to the Directors of Nursing of the long-term-care facilities with the request that, if another individual was better able to complete it, the survey be forwarded to them. RESULTS: Completed responses were obtained from 88% (395/445) of all long-term-care facilities in Minnesota. Forty-eight institutions (12%) had residents colonized or infected with MRSA. Only four (8%) of these facilities stated that MRSA was a problem; however, 33 (69%) of facilities with MRSA had sought outside help or consultation from a variety of sources for its control. Few facilities (7%) had cultured residents specifically for MRSA. Policies regarding the admission of colonized or infected persons were reported by 14% and 21% of facilities, respectively, and over 40% of these policies stated that persons with MRSA would not be accepted. Policies regarding the care of MRSA-colonized or -infected persons were not uniform. Both metropolitan and non-metropolitan facilities had residents with MRSA. CONCLUSIONS: Our results suggest that MRSA in long-term-care facilities may be a widespread and underrecognized problem. There is a need to develop uniform policies for the control of MRSA in nursing homes. These policies should consider the sources and objectives of long-term-care facilities.
Cross Infection↗
Serodiagnosis of equine monocytic ehrlichiosis in selected groups of horses in Minnesota.
Antibody titer to Ehrlichia risticii was determined, in 2,549 equine serum samples, using an indirect fluorescent antibody assay. During 1986, samples were obtained from the Minnesota State-Federal Equine Infectious Anemia Diagnostic Laboratory, the Minnesota Racing Laboratory, from horses admitted to the University of Minnesota Veterinary Teaching Hospital, and as a result of field investigations of horses with acute diarrhea. Results of the study revealed antibody prevalence of 33, 24, 47, and 25% for the respective groups. There was no statistical association between seropositive status and age, sex, breed, or clinical problem of horses referred to the teaching hospital. There was an increase in the total percentage of seropositive samples over the duration of the sample collection period, suggesting a seasonal exposure pattern, and E risticii was associated with clinical and subclinical infections in horses of Minnesota.
Animals↗
Access to hospital services in rural Minnesota.
A Minnesota Department of Health study on the financial condition of Minnesota's small, rural hospitals found that at least 12 hospitals were in precarious financial condition at the start of 1989, and many other hospitals were financially vulnerable. One-third or more of Minnesota's hospitals with fewer than 50 beds had negative net income in each year from 1984 to 1987. Using a standard of 30 minutes' maximum travel time for adequate access, the study revealed that about 19,000 Minnesotans in 14 counties currently have inadequate access to hospital services. Closing rural hospitals could leave additional Minnesotans without adequate access to hospital services. Given the financial condition of Minnesota's small, rural hospitals and the importance of maintaining access to hospital services in rural communities, the state may need to provide limited hospital subsidies to ensure access in geographically isolated areas.
Health Services Accessibility↗
Protective effects of polyclonal sera and of monoclonal antibodies active to Salmonella minnesota Re595 lipopolysaccharide during experimental endotoxemia.
Mice were passively immunized with sera from blood donors active for rough lipopolysaccharides (LPS), the J5 (Rc chemotype) mutant of Escherichia coli O111:B4, and the Re595 (Re chemotype) mutant of Salmonella minnesota. All protected the mice against lethal challenge with smooth E. coli WF96 LPS, E. coli and Salmonella rough mutant LPS, or free lipid A. Epitopes recognized by monoclonal antibodies (MAbs) reacting with the LPS of S. minnesota Re595 or lipid A were localized in the 2-keto-3-deoxy-D-manno-octulosonic acid (KDO) region and on lipid A. Core-reactive MAbs reacted with their homologous Re LPS and with free lipid A. One, GL11, cross-reacted with the KDO alone. MAbs GL6, GL11, L.4, L.6, and L.8 protected the actinomycin D-sensitized mice against the lethal effects of LPS from E. coli WF96, Salmonella enteritidis, E. coli J5, S. minnesota Re595, and free lipid A. The GL11 antibody was also protective when injected after LPS challenge. These results indicate that antibodies directed against the core glycolipid of S. minnesota Re595 LPS may be useful as an additive form of therapy that may enable decreased mortality during gram-negative bacterial sepsis.
Animals↗
Comparison of the opsonic activity of polyclonal and monoclonal antibodies raised against Salmonella minnesota strain R595.
Murine monoclonal antibodies and immune rabbit serum were raised against the rough mutant Salmonella minnesota strain R595. These antibodies were tested for their opsonic activity against the homologous strain and the smooth wild type S. minnesota by luminol-dependent chemiluminescence and a microscopic assessment of phagocytosis. Immune rabbit serum opsonised both strains. Treatment with normal rabbit serum inhibited the phagocytic uptake of S. minnesota R595. None of the monoclonal antibodies RE01 (anti-KDO), RE12 (anti-KDO) and RE23 (anti-lipid A) were opsonic. Unopsonised S. minnesota R595 stimulated marked chemiluminescence possibly because of its hydrophobic surface, but this was not reflected in increased uptake by phagocytic cells. Results obtained with luminol-dependent chemiluminescence should be interpreted with caution when the opsonisation of rough bacterial strains or those with high surface hydrophobicity is being investigated.
Animals↗
The Minnesota Clinical Comparison and Assessment Project.
Efforts to quantify and improve the effectiveness and efficiency of health care services are critical to the health care system in the United States. Essential components of these efforts are clinician involvement and support and reliable clinical information systems. Organized medicine and the hospital industry in Minnesota have initiated and funded the Minnesota Clinical Comparison and Assessment Project (MCCAP) to begin to document, compare, and improve health care services. Through MCCAP, a forum, comprising leaders in the Minnesota health care community, oversees efforts to collaboratively identify and address quality of care. In addition, MCCAP will adapt guidelines for specific conditions/procedures, collect hospital-level data on clinical practices in the state relative to those conditions/procedures, and provide feedback so that physicians can evaluate their practice and modify it, if necessary, to improve quality of care.
Clinical Competence↗
The home care practice and attitudes of Minnesota family physicians.
OBJECTIVE: Assess home care practice and attitudes of Minnesota family physicians (FPs). DESIGN: Mailed survey. SETTING: State of Minnesota. PARTICIPANTS: Members of the Minnesota Academy of Family Physicians, 80% of the FPs practicing in the state. INTERVENTION: A 55-item mailed, self-complete questionnaire regarding general practice and personal physician characteristics (18 questions), specific questions regarding geriatric and home care practice and related attitudes (37 questions); up to four reminder or follow-up surveys were sent. MAIN OUTCOME MEASURES: Descriptive summary of FP home care practice and attitudes. RESULTS: Eighty percent of surveys were completed, 76% of responding physicians made at least one home visit in the previous year, and 92% of home visits were to geriatric patients. Discriminant function analysis identified six significant (P less than 0.001) variables that explained 52% of the variance (r2 = 0.52, Wilks Lambda = 0.48) in home visiting behavior between frequent home visiting FPs (greater than 24 visits/year) and non-visiting FPs. FPs most likely to do home visiting were older and tended to have small group or solo practices in rural settings. CONCLUSION: The survey documented continued decline (from previously published surveys) of physician home visiting behavior and widespread dissatisfaction with reimbursement. However, attitudes regarding home care provided by other professionals were highly positive.
Attitude of Health Personnel↗
Computerized placement in dentistry: the Minnesota experience.
In response to identified manpower information and service requirements, the Minnesota Dental Association, the board of dentistry, and the University of Minnesota School of Dentistry established the Dental Information Service Center in 1972. One major effort of the center was to develop a computerized placement service for dentistry in the state. This service was recently subjected to a user evaluation. Of 1,030 delivered questionnaires, 431 were returned in response to a single mailing. The respondents included 216 employers and 215 employees, including dentists seeking positions. Dental employers generally found the system to be their most successful strategy in the search for employees; from the perspective of employees, other sources such as personal contact competed with the computerized system as the most successful source of information. Evidence from this evaluation indicates that the computerized placement experience in Minnesota has been quite positive. Dentists have relied on the service somewhat more heavily than other dental occupational groups, possibly because alternate sources of information traditionally have not served the health professions. Overall satisfaction ran quite high, and an overwhelming majority of the respondents thought that the service should be continued and expanded to either a regional or a national level.
Dentistry↗
Impact of the Minnesota Parental Notification Law on abortion and birth.
BACKGROUND: The impact of the Minnesota Parental Notification Law on abortion and birth was examined. METHODS: Using linear models, outcome parameters were compared before and after enactment of the law. Time by age group interactions also were examined. RESULTS: The pre-enactment to post-enactment change in the Minnesota abortion rate reflected a greater decline for minors (less than or equal to 17 years old) than for 18-19 year-olds (who were not under the law). An increase in abortion rate occurred for women ages 20-44. The law appeared to have had no impact on birth rate in minors. Following the enactment of the law, the rate of early abortions (less than or equal to 12 weeks) declined among minors more than the rate of late abortions (greater than 12 weeks). This resulted in a pre-enactment to post-enactment increase in the ratio of late-to-early abortions among minors. CONCLUSIONS: These data suggest that parental notification facilitated pregnancy avoidance in 15-17 year-old Minnesota women. Abortion rates declined unexpectedly while birth rates continued to decline in accordance with a long-term trend.
Abortion, Legal↗
The Patient Self-Determination Act. Advance directives available to Minnesota patients.
The Patient Self-Determination Act requires most health care institutions to inform patients of their right to refuse medical care and their right to provide advance direction regarding their wishes should they become incompetent. Although the PSDA does not apply to physicians, it will probably increase the demand for communication with patients on such matters. Patients will undoubtedly ask how to formulate advance directives. While physicians should make it clear that they are not providing legal advice to patients on such issues, they may wish to indicate that a guardianship and a living will are options available under Minnesota law. Additionally, as indicated above, a number of arguments exist that durable powers of attorney for health care are valid in Minnesota, as well. Physicians should familiarize themselves with living will forms and may wish to make them available to patients upon request. (Living will forms can be obtained by contacting the Minnesota Medical Association at 612/378-1875.) Patients with questions regarding durable powers of attorney should be advised to seek legal counsel.
Advance Directives↗
The impact of judicial review of patients' refusal to accept antipsychotic medications at the Minnesota Security Hospital.
In 1988, the Minnesota Supreme Court ruled that premedication judicial review was required to force antipsychotic medications on incompetent committed patients in Minnesota. Before this decision all patients refusing antipsychotic medications at state hospitals were reviewed by an internal multidisciplinary peer review organization called the Treatment Review Panel (TRP). The author examined the impact of judicial review of medications at the Minnesota Security Hospital. Thirty-one patients reviewed by the Treatment Review Panel (TRP) between July 1986 and December 1987 were compared with 37 patients reviewed by the TRP and the court between January 1988 and December 1989. There was nearly unanimous agreement between the TRP and the court in approving antipsychotic medications for patients. However, for patients awaiting judicial review for medication, an average delay of 80 days was encountered, and there was a significant increase in the number of emergencies occurring on the treatment unit before the initiation of treatment. Complications of the long delay in approving medications included the diversion of limited mental health money to cover the costs of judicial review, diversion of physicians from direct patient care to provide testimony, inconsistent judicial medication and monitoring decisions, and compromise of medical judgment to meet judicial requirements. The study concluded that there was no advantage of judicial review over the previous Treatment Review Panel function.
Adult↗
Economic cost of diabetes mellitus--Minnesota, 1988.
For diabetes mellitus (DM) and other chronic diseases, important indicators of disease burden include morbidity, mortality, measures of disability and quality of life, and economic burden. Because of limited data, however, the economic burden of DM has been difficult to measure. Although national costs for DM have been estimated recently (1-5), state-specific estimates have, in general, not been possible. This report summarizes an analysis prepared by the Minnesota Diabetes Surveillance Project (MDSP), Minnesota Department of Health, that estimated the economic impact of DM in Minnesota for 1988.
Diabetes Complications↗
Trends in rates for mortality from all causes among Indians in Minnesota, 1960-79.
Trends in age- and sex-specific mortality rates for all causes of death for Indians in Minnesota during the years 1960-79 were examined using the Mantel-Haenszel chi-square extension test. Indians younger than 15 years of age were not included in the analysis because of the changes in classification for Indian race in census reports for Indian children and adolescents, known decreases in Indian infant mortality, and the small number of deaths among Indian children and adolescents during the years 1960-79. Declines in mortality rates were observed for Indian men and women 75 years of age and older, men 65 through 74 years of age, and women 25 through 54 years of age. Overall, only 8 percent of men and 53 percent of women were in age groups that showed declining mortality rates for all causes of death during the years 1960-79. The greatest decline in mortality rates for men and women occurred among those 75 years of age and older. Mortality rates for Indians in Minnesota declined during the study period for fewer than half of the age groups. Such strategies as risk factor surveillance, public health programs, and medical interventions need to be directed toward these groups that have not experienced the same declines in mortality rates as nearly all age groups of whites, both nationwide and in Minnesota, during the same period.
Adolescent↗