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The article discusses the navigating manuscript rejection. Topics include the study demonstrating how common manuscript rejection is among faculty of all academic ranks in hopes to normalize rejection and open conversations about rejection in mentorship; approach, innovations related to the study design, and reason for the rejection of the study to quantify on the fate of manuscripts.

Purpose The prevalence of intimate partner domestic violence (DV) increased in frequency during the global COVID-19 pandemic. The purpose of this pilot study was to assess dental hygienists' knowledge, attitudes, and readiness to manage patients experiencing DV in the state of Minnesota. Methods A cross-sectional study design was used on a convenience sample of dental hygienists. The validated Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS) was used to collect the data. Survey items included demographic variables and measured attitudes and knowledge regarding intimate partner DV. Paper surveys were distributed to attendees at the Minnesota Dental Hygienist Association Annual Meeting. ANOVA and linear regression models were used to assess associations between domestic violence knowledge scores and respondent demographics and attitudes. Results Eighty-eight surveys were distributed; 31 surveys were completed and met the inclusion criteria for data analysis. The overall mean knowledge score was 11.6 from a possible score of 17. No significant differences were found by age, degree type, or years in practice and domestic violence knowledge or attitudes. Most respondents (64.5%) indicated a lack of preparedness to ask appropriate questions regarding DV and only a little more than half knew how to respond to disclosures of DV (51.6%) or were aware of the state's legal requirements for reporting DV (58.0%). Conclusion Participants demonstrated moderate knowledge of DV and recognized the importance of identifying and providing support for DV victims. However, participants were unsure of current state-mandated guidelines for reporting DV. Future exploration of reporting mandates will better support dental hygienists in their professional obligations identifying victims of DV. [ABSTRACT FROM AUTHOR]

Performance measurement and public reporting are increasingly being used to compare clinic performance. Intended consequences include quality improvement, value-based payment, and consumer choice. Unintended consequences include reducing access for riskier patients and inappropriately labeling some clinics as poor performers, resulting in tampering with stable care processes. Two analytic steps are used to maximize intended and minimize unintended consequences. First, risk adjustment is used to reduce the impact of factors outside providers' control. Second, performance categorization is used to compare clinic performance using risk-adjusted measures. This paper examines the effects of methodological choices, such as risk adjusting for sociodemographic factors in risk adjustment and accounting for patients clustering by clinics in performance categorization, on clinic performance comparison for diabetes care, vascular care, asthma, and colorectal cancer screening. The population includes all patients with commercial and public insurance served by clinics in Minnesota. Although risk adjusting for sociodemographic factors has a significant effect on quality, it does not explain much of the variation in quality. In contrast, taking into account the nesting of patients within clinics in performance categorization has a substantial effect on performance comparison. [ABSTRACT FROM AUTHOR]

Objectives: The University of Minnesota (UMN) Health Sciences Libraries conducted a needs assessment of public health researchers as part of a multi-institutional study led by Ithaka S+R. The aims of the study were to capture the evolving needs, opportunities, and challenges of public health researchers in the current environment and provide actionable recommendations. This paper reports on the data collected at the UMN site. Methods: Participants (n=24) were recruited through convenience sampling. One-on-one interviews, held November 2016 to January 2017, were audio-recorded. Qualitative analyses were conducted using NVivo 11 Pro and were based on the principles of grounded theory. Results: The data revealed that a broad range of skill levels among participants (e.g., literature searching) and areas of misunderstanding (e.g., current publishing landscape, open access options). Overall, data management was an afterthought. Few participants were fully aware of the breadth of librarian knowledge and skill sets, although many did express a desire for further skill development in information science. Conclusions: Libraries can engage more public health researchers by utilizing targeted and individualized marketing regarding services. We can promote open science by educating researchers on publication realities and enhancing our data visualization skills. Libraries might take an institution-wide leadership role on matters of data management and data policy compliance. Finally, as team science emerges as a research priority, we can offer our networking expertise. These support services may reduce the stresses that public health researchers feel in the current research environment. [ABSTRACT FROM AUTHOR]

This paper aims to describe the prevalence of parent-adolescent conversations about eating, physical activity and weight across sociodemographic characteristics and to examine associations with adolescent body mass index (BMI), dietary intake, physical activity and sedentary behaviors. Data from two linked epidemiological studies were used for cross-sectional analysis. Parents (n = 3,424; 62 % females) and adolescents (n = 2,182; 53.2 % girls) were socioeconomically and racially/ethnically diverse. Fathers reported more parent-adolescent conversations about healthful eating and physical activity with their sons and mothers reported more weight-focused conversations with their daughters. Parents of Hispanic/Latino and Asian/Hmong youth and parents from lower socioeconomic status categories engaged in more conversations about weight and size. Adolescents whose mothers or fathers had weight-focused conversations with them had higher BMI percentiles. Adolescents who had two parents engaging in weight-related conversations had higher BMI percentiles. Healthcare providers may want to talk about the types of weight-related conversations parents are having with their adolescents and emphasize avoiding conversations about weight specifically. [ABSTRACT FROM AUTHOR]

Purpose: Reported cases of obstructive sleep apnea (OSA) range between 4% to 9%, however between 70% to 90% of adults in the United States remain undiagnosed. The purpose of this study was to determine the current knowledge and attitudes of OSA among Minnesota dental hygienists and inventory OSA screening protocols currently used in dental practices. Methods: The cross sectional study used an adapted Obstructive Sleep Apnea Knowledge and Attitude (OSAKA) survey instrument. Survey items included demographic variables, and measured attitudes, knowledge and perceived knowledge about OSA, routine screening procedures, and use of validated OSA screening protocols. Paper surveys were mailed to a random sample of 750 licensed Minnesota dental hygienists. Analyses included descriptive statistics (counts and frequencies), and analytic tests (one-way ANOVA, Pearson's correlation, and t-tests, Cronbach's alpha), as appropriate. Results: Twenty-six percent of the returned surveys met inclusion criteria (n=197) and were used in the final analyses. Respondent age ranged from 19 to 70 years and mean years in practice experience was 19.9. The majority (93.9%) were in general practice and had completed an associate degree (59.6%). The mean (SD) self-rated OSA knowledge was 3.5 (3.3) on a scale of 0-10, attitude score was 3.2 (0.8) on a 5-point Likert scale, and knowledge score was 9.5 (range 0-17). No significant differences were found by age, degree type, or years in practice and OSA knowledge or attitudes. Routine practices included head and neck exams (89.3%), taking blood pressure (41.6%). Using a validated OSA screening protocol was reported by 9.6% of the respondents. Conclusion: Dental hygienists perceive that assessing patients for OSA is important, however they have moderate knowledge of the disease. Results support incorporating OSA into dental hygiene practice through additions to the dental hygiene education curriculum and ongoing professional development courses with the goal of improving the screening and referral of patients presenting with OSA symptoms. [ABSTRACT FROM AUTHOR]

Objective: To examine the racial, ethnic and cultural differences in postpartum participation of women who participated in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) during pregnancy by completing a retrospective analysis of observational data on 35,903 women who enrolled in Minnesota WIC during pregnancy, from April 2018 to March 2020. Methods: Descriptive analyses were completed using chi-square tests of association to show differences in postpartum WIC participation by maternal demographics and health risk codes of the WIC participants. Binary logistic regression and multivariate logistic regression were used to obtain odds ratios to compare the likelihood of postpartum WIC participation across different races, ethnicities and cultural groups. Results: Asian/Pacific Islander, East African, Hispanic, Hmong, Multigenerational Black, and Other Black pregnant participants were more likely than White participants to return to WIC postpartum (adjusted odds ratio (AOR) 2.54, 95% confidence interval (CI) 1.87–3.46; AOR 3.35, 95% CI 2.40–4.66; 1.30, 95% CI 1.10–1.54; AOR 6.76, 95% CI 4.39–10.42; AOR 1.40, 95% CI 1.11–1.77, AOR 1.52, 95% CI 1.26–1.83, respectively). American Indian pregnant participants were less likely than White participants to return to WIC postpartum (AOR 0.70, 95% CI 0.54–0.92). Conclusions for Practice: These findings can help the Minnesota WIC program, as well as other WIC programs, better understand which cultural groups may need more specific outreach strategies to keep women participating in the program after giving birth. Further research is needed to understand why postpartum women choose to participate, or choose not to participate, in WIC. Significance: It is already known that culture, race and ethnicity influence the likelihood of WIC program participation. Research also has shown that WIC participation can have positive impacts on the health of women, infants and children. This research adds depth to previous findings on prenatal WIC participation by describing the differences in postpartum WIC participation by race, ethnicity and cultural group. This research can be used for outreach planning within the WIC program. [ABSTRACT FROM AUTHOR]

Little research has examined mechanisms driving cannabis use disparities among sexual minority (SM; versus heterosexual) young adults (YAs). Participants were US YA women (N  = 1345; 24.8% bisexual, 6.1% lesbian) and men (N  = 998: 8.9% bisexual, 13.8% gay). Bivariate analyses examined associations between sexual orientation (heterosexual, gay/lesbian, bisexual) and cannabis use outcomes (past 30-day [current] use, use frequency, cannabis-tobacco dual use, use intentions), perceived risks (harm, addictiveness) and social norms (social acceptability, peer use). Regressions examined sexual orientation, perceived risks and social norms as correlates of cannabis outcomes. Bisexual and lesbian (versus heterosexual) women reported lower cannabis-related perceived risks, greater social norms and higher odds of current use. Bisexual (versus heterosexual) women reported more days of use, higher odds of cannabis-tobacco dual use and greater use intentions. Gay (versus heterosexual) men reported lower perceived addictiveness, greater social norms and higher odds of current use. Lower perceived risks and greater social norms predicted greater use outcomes for women and men. Bisexual women displayed higher odds of several cannabis use outcomes, whereas lesbian women and gay men displayed higher odds of current cannabis use only. Cannabis-related perceptions and social norms may be important targets for public health messaging for SMYAs. [ABSTRACT FROM AUTHOR]

Objective E-cigarette use has rapidly increased. Recent studies define prevalence using a variety of measures; competing definitions challenge cross-study comparison. We sought to understand patterns of use by investigating the number of days out of the past 30 days when adults had used e-cigarettes. Design We used the 2014 Minnesota Adult Tobacco Survey, a random digit dial population survey (n=9304 adults). Questions included ever using e-cigarettes, number of days used in the past 30 days and reasons for use. Smoking status was determined by combustible cigarette use. Histograms of e-cigarette use were visually inspected for current, former and never smokers with any 30-day e-cigarette use. Different definitions of current use were compared. Results Use ≤5 days in the past 30 days demarcated a cluster of infrequent users at the low end of the distribution. Among those with use in the past 30 days, infrequent users were the majorities of current (59%) and never smokers (89.5%), but fewer than half of former smokers (43.2%). Infrequent users were more likely to cite curiosity and less likely to cite quitting/ cutting down other tobacco use as reasons for use. Conclusions Defining adult prevalence as any use in the past 30 days may include experimenters unlikely to continue use, and is of questionable utility for population surveillance of public health trends over time. Defining prevalence as >5 days excludes those infrequent users. [ABSTRACT FROM AUTHOR]

Over the past two decades, America taken part of a broader global trend of "memorial mania" in which memorials dedicated to remembering injustice have exploded into public space. Memorials that facilitate the centering of marginalized narratives of violence hold significant power for social change. This article focuses on one such space: The Survivors Memorial in Minneapolis, Minnesota. The Survivors Memorial opened in October 2020 and is the first public memorial honoring survivors of sexual violence. Despite the progress of the anti-rape and feminist movements as well as a variety of legal interventions designed to address sexual violence and empower, many survivors are left without a sense of justice or institutional or community recognition. Drawing on 21 in-depth, qualitative interviews with individuals involved in all aspects of the memorial project, this article documents how one community mobilized to create a space for survivors whose voices are often overlooked, disbelieved and silenced by the criminal justice system, practitioners, and communities. In focusing on how participants narrate the significance and meaning of the Survivors Memorial, this article uncovers how social, political, and local circumstances coalesced to make the Memorial possible. These factors include local leadership, the prevalence of sexual violence, the unique structure of the Minneapolis park structure, and the rise of the #MeToo movement. Interviews illuminate that participants worked to intentionally construct the Memorial as an accessible and visible space that centers on providing all sexual violence survivors with public acknowledgment of their experiences, while simultaneously engaging community members in dialogs about sexual violence, ultimately, laying the foundation for sexual violence prevention efforts. [ABSTRACT FROM AUTHOR]

Prior evidence suggests an association among food insecurity, poor health, and increased health care spending. In this study, we are using a natural experiment to confirm if longer participation in the Supplemental Nutrition Assistance Program (SNAP) is associated with reduced Medicaid spending among a highly impoverished group of adults. In 2013, the mandatory work requirements associated with SNAP benefits were lifted for able-bodied adults without dependents (ABAWDs). Using 2013 to 2015 Medicaid and SNAP data of 24,181 Minnesotans aged 18–49, we examined if changes in SNAP enrollment duration affect health care expenditures. In fully adjusted within-participant regression models, for each additional month of SNAP, average annual health care spending was $98.8 lower (95% CI: –131.7, –66.0; p<.001) per person. Our data suggests that allowing ABAWDs to receive SNAP even in months they are not working may be critical to their health as well as cost-effective. [ABSTRACT FROM AUTHOR]

Background: As the COVID-19 pandemic has unfolded, understanding the virus and necessary measures to prevent infection have evolved. While effective preventative measures for COVID-19 have been identified, there are also identifiable barriers to implementation. Objective: Explore the access to information, knowledge, and prevention methods and barriers of COVID-19 among Somali, Karen, and Latinx immigrant community members in Minneapolis, Minnesota, USA through analysis of in-depth interviews. Methods: Data were collected through 32 interviews via phone, video conference on a computer, or in-person with Somali, Karen, and Latinx adults to understand the experiences during the COVID-19 pandemic in each group's native language. All participants were over the age of 18, and identified as Somali, Karen, and Latinx refugee or immigrant. Interview protocol contained 9 main questions including probes. Data were analyzed through use of the qualitative analysis software, Atlas.ti using phenomenology. Results: A total of 32 adults were interviewed (Somali = 12, Karen = 10, and Latinx = 10). One-third were in person and the remainder were remote. The average age recorded was 37 years (range 20-66 years), 43.8% males and 56.3% females. Somali, Karen, and Latinx respondents consistently had accurate knowledge about COVID-19 and were attentive to finding trustworthy information. Information was available in Somali, Karen, and Latinx written language, although Karen elders who are not literate would benefit more from video messaging. Knowledge of preventive measures was consistent; however, barriers included access, working in front-line positions, and living in high density housing. Conclusion: Exploring the impact of COVID-19 on Somali, Karen, and Latinx community members in Minneapolis, MN is advantageous in removing identified barriers and disparities in health. The results of this study highlight the need for increased efforts to address barriers in the prevention of COVID-19, as well as future pandemics for immigrant and refugee populations. [ABSTRACT FROM AUTHOR]

Evidence-based practice (EBP) is a core skill of health professionals and one that is regularly taught in health sciences programs. This report covers the design and results of an interprofessional EBP workshop at a large university aimed at improving faculty's confidence in practicing and teaching EBP. The two-day workshop was designed by the University's Health Sciences Libraries and emphasized small-group work, with the first day focused on critical appraisal and searching and the second on effective teaching strategies. Twenty-five faculty from the schools and colleges of Medicine, Nursing, Pharmacy, Dentistry, and Veterinary Medicine and the Center for Allied Health Programs attended this study. Nine faculty and librarians served as instructors. Attendees rated the workshop and individual lectures highly and reported that it improved their ability to both practice and teach EBP. In addition, they reported a preference for learning in an interprofessional environment. This report suggests that a short EBP workshop can improve faculty members' self-reported confidence and ability to practice and teach core EBP skills. [ABSTRACT FROM AUTHOR]

This study aimed to better understand African Americans' perceptions of menthol tobacco and reasons for unsuccessful quit attempts among menthol smokers. A cross-sectional survey of 407 U.S.-born African American adults from Minnesota assessed menthol perceptions and experiences trying to quit menthol cigarettes. A majority of the sample (59%) was either unsure of the relative harm of menthol cigarettes or perceived that menthol cigarettes are less harmful than non-menthol cigarettes. Menthol smokers were more likely than nonsmokers to perceive that menthol makes it easier to start smoking and harder to quit, and that menthol cigarettes are marketed to African Americans more than other groups (ps <.05). Nearly half (45%) of menthol smokers who reported a failed quit attempt identified cravings as a reason why they were unsuccessful. Media campaigns and educational interventions that highlight the dangers of menthol and promote cessation resources are needed to help reduce the pernicious effects of menthol in the African American community. [ABSTRACT FROM AUTHOR]

Anti-smoking norms and educational aspirations are established tobacco prevention targets for general United States (U.S.) adolescent populations but protective factors remain poorly characterized for Somali-American youth. Here we describe patterns of past 30-day tobacco use and associated protective factors among eighth, ninth, and eleventh grade Somali adolescent respondents (n = 2009) to the 2016 Minnesota Student Survey using multivariate logistic regressions. E-cigarette (5.7%) and hookah (5.0%) use were most prevalent. Male youth reported higher levels of tobacco use across products. Adjusted odds ratios showed that internal developmental assets (e.g., e-cigarettes aOR 0.37, 95% CI 0.37, 0.79) and parental anti-smoking norms (e.g., e-cigarettes aOR 0.19, 95% CI 0.09, 0.38) protected against use of all tobacco products. E-cigarettes and hookah are prevalent among U.S. Somali youth, highlighting the need for prevention efforts that address emerging tobacco products and leverage protective factors such as internal assets and parental anti-smoking norms. [ABSTRACT FROM AUTHOR]

BACKGROUND There is limited evidence addressing the impact of adverse childhood experiences (ACEs) on adolescent sexual risk behaviors and pregnancy. In this study, we examined whether individual and cumulative ACEs increased the risk of unhealthy sexual behaviors and adolescent pregnancy. To inform intervention efforts, potential mediating mechanisms focusing on youth developmental assets were examined to explain the association. METHODS: Analyses included 88,815 (9th and 11th grade) students who completed the Minnesota Student Survey in the spring of 2016. RESULTS: Adolescents who reported each category of ACEs were more likely to initiate sex, have multiple sex partners, engage in unprotected sex, and be involved in pregnancy. Different youth assets, included self‐regulation skills, connectedness to school, not skipping school, and academic performance, were associated with lower likelihood of sexual initiation and sexual risk‐taking. They served as important mediators to reduce, though not completely diminish, the adverse effects of ACEs on sexual initiation and adolescent pregnancy. CONCLUSIONS: The results suggest that the relationship between ACEs and adolescent sexual risk behaviors and pregnancy is strong and graded. Effective school initiatives and intervention efforts should encourage the development of self‐regulation and connectedness to school among teens who had been exposed to ACEs. [ABSTRACT FROM AUTHOR]

People with mental illness not only suffer from psychiatric symptoms but also have higher chances of having chronic diseases. Due to medical comorbidity, they tend to experience the decreased health-related quality of life (HRQOL). The benefits of physical activity are well known, but few studies have examined the role of physical activity between medical comorbidity and HRQOL among people with mental illness. The purpose of this study was to examine the effect of physical activity on psychological distress, medical comorbidity, and HRQOL. A total of 3,797 individuals with mental illness were selected from the 2013 Behavioral Risk Factor Surveillance System. Analyses included multiple regression, structural equation modeling, and bootstrapping to examine a moderated mediation effect. Medical comorbidity affects HRQOL as it is mediated by decreased psychological distress. Higher levels of physical activity diminished the impact of medical comorbidity on psychological distress, which in turn decreased the negative impact of medical comorbidity on HRQOL. Study findings highlight that increased levels of physical activity could benefit people with mental illness in decreasing psychological distress and improving HRQOL. The findings suggest that mental health service providers and stakeholders need to consider integrating physical activity interventions into services and comprehensive psychiatric rehabilitation. [ABSTRACT FROM AUTHOR]

Objectives: In the current study, we aimed to compare the levels of and factors associated with mental health attitude between males and females. Of particular interest was ascertaining the degree to which mental health literacy was related to mental health attitude and whether this relationship would vary by gender. Methods: A total of 732 participants aged 18 years or more were recruited from attendees at the 2016 Minnesota State Fair. We used the Mental Health Literacy Scale (MHLS) to measure attitude toward and literacy of mental health. Results: Our multivariate analysis reported that males' mental health attitude was significantly lower than females. Some factors associated with mental health attitude differed by gender as well. Among men, receiving more social support, experiencing higher levels of depression, and being married predicted greater mental health attitude. Among women, older age was associated with lower mental health attitude levels. However, mental health literacy was the strongest factor regardless of gender. Men and women with greater mental health literacy had a more positive mental health attitude. Conclusions: Provision of tailored mental health literacy education both for males and females could potentially improve the public's mental health attitude toward mental illness. [ABSTRACT FROM AUTHOR]

Colorectal Cancer (CRC) is common in Lao Americans, but screening is suboptimal. To investigate CRC screening rates of Lao Americans in Minnesota, and how predisposing characteristics, enabling resources, and perceived need are associated with screening. We conducted a convenience-sample cross-sectional survey of 50–75-year-old Lao Americans, using step-wise multivariate logistic regression to identify factors associated with ever being screened. Of the 118 survey participants, 45% ever received CRC screening. In univariate regression, some enabling resources (having a primary care provider, higher self-efficacy in pursuing screening) and perceived needs (knowledge of who should be screened, higher number of chronic illnesses) were associated with screening. In multivariate logistic regression, the odds of ever being screened was 12.4 times higher for those with a primary care provider than for those without (p = 0.045). The findings reinforce a need for developing culturally tailored interventions focused on Lao-American immigrants to promote CRC screening. [ABSTRACT FROM AUTHOR]

To create more direct and equal collaborations with faculty, the University of Minnesota Libraries in the Twin Cities adapted a new model of engagement: the "Research Sprints." Research Sprints place librarians in direct proximity with faculty to rapidly and collaboratively work on a component of a research project in less than a week. In this article, we use a grounded theory approach, in which researchers review the data they have collected to find repeated ideas and then group them into concepts or categories, to analyze survey results from faculty and librarian participants across three iterations of Research Sprints. Research Sprints offer academic libraries an opportunity to build social capital with faculty but require strong project management to succeed. [ABSTRACT FROM AUTHOR]

Retrospective studies using adult self-report data have demonstrated that adverse childhood experiences (ACEs) increase risk of violence perpetration and victimization. However, research examining the associations between adolescent reports of ACE and school violence involvement is sparse. The present study examines the relationship between adolescent reported ACE and multiple types of on-campus violence (bringing a weapon to campus, being threatened with a weapon, bullying, fighting, vandalism) for boys and girls as well as the risk of membership in victim, perpetrator, and victim–perpetrator groups. The analytic sample was comprised of ninth graders who participated in the 2013 Minnesota Student Survey (n ~ 37,000). Multinomial logistic regression models calculated the risk of membership for victim only, perpetrator only, and victim–perpetrator subgroups, relative to no violence involvement, for students with ACE as compared with those with no ACE. Separate logistic regression models assessed the association between cumulative ACE and school-based violence, adjusting for age, ethnicity, family structure, poverty status, internalizing symptoms, and school district size. Nearly 30% of students were exposed to at least one ACE. Students with ACE represent 19% of no violence, 38% of victim only, 40% of perpetrator only, and 63% of victim–perpetrator groups. There was a strong, graded relationship between ACE and the probability of school-based victimization: physical bullying for boys but not girls, being threatened with a weapon, and theft or property destruction (p s <.001) and perpetration: bullying and bringing a weapon to campus (p s <.001), with boys especially vulnerable to the negative effects of cumulative ACE. We recommend that schools systematically screen for ACE, particularly among younger adolescents involved in victimization and perpetration, and develop the infrastructure to increase access to trauma-informed intervention services. Future research priorities and implications are discussed. [ABSTRACT FROM AUTHOR]

Objective: To understand the interaction of multimorbidity and functional limitations in determining health-care utilization and survival in older adults. Methods: Olmsted County, Minnesota, residents aged 60-89 years in 2005 were categorized into four cohorts based on the presence or absence of multimorbidity (=3 chronic conditions from a list of 18) and functional limitations (=1 limitation in an activity of daily living from a list of 9), and were followed through December 31, 2016. Andersen-Gill and Cox regression estimated hazard ratios (HRs) for emergency department (ED) visits, hospitalizations, and death using persons with neither multimorbidity nor functional limitations as the reference (interaction analyses). Results: Among 13,145 persons, 34% had neither multimorbidity nor functional limitations, 44% had multimorbidity only, 4% had functional limitations only, and 18% had both. Over a median follow-up of 11 years, 5906 ED visits, 2654 hospitalizations, and 4559 deaths occurred. Synergistic interactions on an additive scale of multimorbidity and functional limitations were observed for all outcomes; however, the magnitude of the interactions decreased with advancing age. The HR (95% confidence interval) for death among persons with both multimorbidity and functional limitations was 5.34 (4.40-6.47) at age 60-69, 4.16 (3.59-4.83) at age 70-79, and 2.86 (2.45-3.35) at age 80-89 years. Conclusion: The risk of ED visits, hospitalizations, and death among persons with both multimorbidity and functional limitations is greater than additive. The magnitude of the interaction was strongest for the youngest age group, highlighting the importance of interventions to prevent and effectively manage multimorbidity and functional limitations early in life. [ABSTRACT FROM AUTHOR]

BACKGROUND: Adolescents frequently miss breakfast which may impact cognitive, academic, and health outcomes. This analysis describes the effect of a trial to assess school level changes to increase breakfast consumption on grade point average (GPA). METHODS: Sixteen rural Minnesota high schools were randomized to a policy and environmental change intervention or delayed intervention (control) group. Baseline screening identified, randomly selected and enrolled 9th and 10th grade students who eat breakfast ≤3 times per school week for assessment. Mean unweighted GPA was provided by 13 schools for 636 students. Student‐level and administrative data were used for sociodemographic and free or reduced‐price meals (FRPM). Linear mixed models and latent class analysis (LCA) were used to assess change in GPA. RESULTS: Students were 54% female, 76% white, and 34% received FRPM. Unweighted cumulative GPA mean = 2.82 (0.78) at baseline. There was no significant intervention effect on GPA postintervention or 1‐year follow‐up. LCA revealed two classes: "higher" (N = 495) and "lower" (N = 141) resource. There was an intervention effect among low‐resource students from baseline to 1‐year post only among the control condition (delayed intervention). CONCLUSIONS: In combination with the full study results, increasing breakfast consumption may have an impact particularly for low resource students. [ABSTRACT FROM AUTHOR]

Background: Anterior cruciate ligament (ACL) injury is one of the most frequent orthopaedic injuries and reasons for time loss in sports and carries significant implications, including posttraumatic osteoarthritis (OA). Instability associated with ACL injury has been linked to the development of secondary meniscal tears (defined as tears that develop after the initial ACL injury). To date, no study has examined secondary meniscal tears after ACL injury and their effect on OA and arthroplasty risk. Purpose: To describe the rates and natural history of secondary meniscal tears after ACL injury and to determine the effect of meniscal tear treatment on the development of OA and conversion to total knee arthroplasty (TKA). Study Design: Cohort study; Level of evidence, 3. Methods: A geographic database of >500,000 patients was reviewed to identify patients with primary ACL injuries between January 1, 1990, and December 31, 2005. Information was collected with regard to ACL injury treatment, rates/characteristics of the secondary meniscal tears, and outcomes, including development of OA and conversion to TKA. Kaplan-Meier and adjusted multivariate survival analyses were performed to test for the effect of meniscal treatment on survivorship free of OA and TKA. Results: Of 1398 primary ACL injuries, the overall rate of secondary meniscal tears was 16%. Significantly lower rates of secondary meniscal tears were noted among patients undergoing acute ACL reconstruction within 6 months (7%) as compared with patients with delayed ACL reconstruction (33%, P <.01) and nonoperative ACL management (19%, P <.01). Of the 235 secondary meniscal tears identified (196 patients), 11.5% underwent repair, 73% partial meniscectomy, and 16% were treated nonoperatively. Tears were most often medial in location (77%) and complex in morphology (56% of medial tears, 54% of lateral tears). At the time of final follow-up, no patient undergoing repair of a secondary meniscal tear (0%) underwent TKA, as opposed to 10.9% undergoing meniscectomy and 6.1% receiving nonoperative treatment (P =.28). Conclusion: Secondary meniscal tears after ACL injury are most common among patients undergoing delayed surgical or nonoperative treatment of their primary ACL injuries. Secondary tears often present as complex tears of the medial meniscus and result in high rates of partial meniscectomy. [ABSTRACT FROM AUTHOR]

This study identified where Minnesotans find online health information, how they use it, their confidence in assessing it, and what they think is missing. In August 2016, the University of Minnesota Health Sciences Libraries conducted a study of adults at the Minnesota State Fair. Convenience sampling yielded a total of 255 participants, with the majority being white, female, urban, and highly educated. Participants valued the ability to access OHI and used it for a variety of purposes. A high percentage of participants thought they had the knowledge, skills, and confidence to navigate OHI, yet were uncertain about indicators of quality. [ABSTRACT FROM AUTHOR]

Abstract: Background: Obstetrical care has been declining in rural communities. We examined patient choices and perspectives from two rural northern Minnesota communities who lost their local obstetrical services in July 2015. Our purpose was to characterize obstetrical use patterns through the years leading to and following the closure and to explore the effects of the closure on these communities. Methods: Information introducing the project and providing access to the survey was mailed to women who received prenatal care in the communities of interest. Responses were analyzed quantitatively and qualitatively. Findings: Two hundred and one participants completed the survey with 356 deliveries reported from 1990 to 2016. Before the closure, there was a trend toward an increasing percentage of women electing regional delivery (P < .001); however, women were still 1.6 times more likely to choose local (62%) than regional (38%) delivery. Reasons for choosing delivery location changed over the decades. While birth experiences remained positive or extremely positive, anxiety about getting to the hospital rose 10‐fold from 1990 to 2016 (5%‐51%, P < .001). Women voiced substantial concern about the lack of local obstetrical services. Qualitative analysis revealed significant negative emotional reactions and concerns for the consequences of this loss for the viability of their rural communities. Conclusions: Choices and opinions about obstetric care have significantly changed from 1990 to 2016 in rural Minnesota. Understanding these changes can help address shifting risks and costs to rural communities here and elsewhere in an effort to support and sustain healthy, viable rural communities. [ABSTRACT FROM AUTHOR]

Objectives: Many patients with cancer use complementary and alternative medicine (CAM), but the quality of CAM documentation in their electronic health records (EHRs) is unknown. The authors aimed to describe (i) the prevalence and types of CAM used after cancer diagnosis and the influence of oncologists on CAM use, as per patients' self-report, and (ii) the prevalence of CAM documentation in the EHR and its consistency with self-reported usage. Design: Patient and provider surveys and chart review. Settings/Location: Medical oncology practices at one institution. Subjects: Patients with cancer at oncologist visits. Outcome measures: Patient self-reported rate of 3-month postvisit CAM use; provider EHR documentation of CAM use or discussion and its concordance with patient self-report. Results: Among 327 patients enrolled, 248 responded to the 3-month postvisit survey. Of these, 158 reported CAM use after diagnosis (63.7%). CAM users were younger (p < 0.001) and had a higher percentage of women (p = 0.03) than nonusers. Modalities most commonly used were supplements (62.6%), special diets (38.6%), chiropractor (28.4%), and massage (28.4%). CAM was used to improve well-being (68.7%), manage adverse effects (35.5%), and fight cancer (22.9%). Oncologists suggested CAM in 22.5% of instances of use. CAM use/discussion was documented for 58.2% of self-reported CAM users. Of the documented modalities, EHR and self-report were concordant for only 8.2%. CAM documentation was associated with physician provider (p = 0.03), older patients (p = 0.01), and treatment with radiation (p = 0.03) or surgery (p = 0.001). After adjusting for other factors, patients with breast cancer or "other" tumor category were four times more likely than patients with gastrointestinal cancer to have CAM use documentation (odds ratio [95% confidence interval]: 4.41 [1.48–13.10]; 3.76 [1.42–9.99], respectively). Conclusions: Most patients with cancer use CAM after diagnosis, yet EHR documentation is complete for very few. Oncologists should inquire about, document, and discuss CAM benefits and harm or refer patients to CAM specialists. [ABSTRACT FROM AUTHOR]

Background: Beliefs have been found to have an effect on how people deal with illness. Therefore, knowing healthcare practitioners’ beliefs about specific high frequency illnesses are vital when caring for vulnerable populations such as school‐age children with chronic illnesses or disorders. Aim: To psychometrically test the Iceland Health Care Practitioner Illness Beliefs Questionnaire for healthcare professionals who are working with families of school‐age children with asthma and attention deficit/hyperactivity disorder. Design: The Iceland Health Care Practitioner Illness Beliefs Questionnaire is a 7‐item Likert‐type instrument with four additional open‐ended questions that was developed from the Iceland Family Illness Belief Questionnaire. The questionnaire is designed to measure a provider's beliefs about their understanding of the meaning of the illness situation for families. The questionnaire was administered to 162 school nurses in Iceland and the state of Minnesota. Method: Two condition‐specific versions of the Iceland Health Care Practitioner Illness Beliefs Questionnaire were developed in this study: one to measure beliefs about families of children with asthma and one to measure beliefs about families of children with attention deficit hyperactivity disorder. Higher scores on the questionnaire indicate that healthcare professionals are more confident in their illness beliefs. After initial development, the questionnaire was translated into English. Participants completed the questionnaire using an online survey platform and parallel study procedures in both countries. Results: Based on exploratory factor analysis using principal component analysis, the Iceland Health Care Practitioner Illness Beliefs Questionnaire was found to have a one‐factor solution with good construct validity (Cronbach's α = 0.91). Confirmatory factor analysis supported the one‐factor solution (Cronbach's α = 0.91). Conclusion: This instrument is a promising tool for measuring illness beliefs among healthcare practitioners in clinical and research settings. [ABSTRACT FROM AUTHOR]

Background The growing use of social media creates opportunities for patients and families to provide feedback and rate individual healthcare providers. Whereas previous studies have examined this emerging trend in hospital and physician settings, little is known about user ratings of nursing homes (NHs) and how these ratings relate to other measures of quality. Objective To examine the relationship between Facebook user-generated NH ratings and other measures of NH satisfaction/experience and quality. Methods This study compared Facebook user ratings of NHs in Maryland (n=225) and Minnesota (n=335) to resident/family satisfaction/experience survey ratings and the Centers for Medicare and Medicaid (CMS) 5-star NH report card ratings. Results Overall, 55 NHs in Maryland had an official Facebook page, of which 35 provided the opportunity for users to rate care in the facility. In Minnesota, 126 NHs had a Facebook page, of which 78 allowed for user ratings. NHs with higher aid staffing levels, not affiliated with a chain and located in higher income counties were more likely to have a Facebook page. Facebook ratings were not significantly correlated with the CMS 5-star rating or survey-based resident/family satisfaction ratings. Conclusions Given the disconnect between Facebook ratings and other, more scientifically grounded measures of quality, concerns about the validity and use of social media ratings are warranted. However, it is likely consumers will increasingly turn to social media ratings of NHs, given the lack of consumer perspective on most state and federal report card sites. Thus, social media ratings may present a unique opportunity for healthcare report cards to capture real-time consumer voice. [ABSTRACT FROM AUTHOR]

This study examined the associations between positive and negative religious coping, symptoms of depression and anxiety, physical and emotional well-being among Somali college students in Minnesota. In this online cross-sectional survey study, 156 participants (ages 18-21, M = 21, SD = 2.3) were recruited. Participants reported using more positive religious coping methods. Negative religious coping was associated with an increase in symptoms of both depression ( b = .06, p = .003) and anxiety ( b = .04, p = .05), and positive religious coping was associated with a decrease in symptoms of depression ( b = −.04, p = .05). [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND The purpose is to determine if altering school breakfast policies and the school breakfast environment will positively impact adolescent beliefs of the barriers and benefits of eating breakfast. METHODS There were 904 adolescents from 16 rural high schools, Minnesota, in the BreakFAST Study who reported eating breakfast fewer than 4 times per week at baseline. Schools were randomized to intervention (N = 8 schools) or delayed intervention (N = 8) condition. The intervention lasted 1 school year. Students completed an online survey of beliefs of barriers and benefits to eating breakfast at baseline and follow-up. Summative scales were created. Bivariate and multivariate linear regression, accounting for clustering by school, was performed using SAS. Sex interaction was tested. Models tested the effect of the intervention on change in summative scales from baseline to follow -up. RESULTS Participants were 54% female, 69.1% white, 36.6% eligible for free or reduced-price meals (FRM) and 13.1% of families received public assistance. The change in reported barriers was significantly different in intervention versus control schools (Net difference = 1.0, p = .03). There was no intervention effect of perceived benefits. CONCLUSIONS A school-based policy and environmental change intervention can successfully reduce perceived barriers to eating school breakfast. [ABSTRACT FROM AUTHOR]

Background Peer counseling (PC) has been associated with increased breastfeeding initiation and duration, but few analyses have examined the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) model for peer counseling or the continuation of breastfeeding from birth through 12 months postpartum. Objectives Identify associations between Minnesota WIC Peer Breastfeeding Support Program services and breastfeeding initiation and continuation. Methods Retrospective analysis of observational data from the Minnesota WIC program's administrative database of women who gave birth in 2012 and accepted a PC program referral prenatally (n = 2219). Multivariate logistic regression and Cox regression models examined associations between peer services and breastfeeding initiation and continuation of any breastfeeding. Results Among women who accepted referral into a PC program, odds of initiation were significantly higher among those who received peer services (Odds Ratio (OR): 1.66; 95% CI 1.19-2.32), after adjusting for confounders. Women who received peer services had a significantly lower hazard of breastfeeding discontinuation from birth through 12 months postpartum than women who did not receive services. (Hazard Ratio (HR) month one: 0.45; 95% CI 0.33-0.61; months two through twelve: 0.33; 95% CI 0.18-0.60). The effect of peer counseling did not differ significantly by race and ethnicity, taking into account mother's country of origin. Conclusion for practice Receipt of peer services was positively associated with breastfeeding initiation and continued breastfeeding from birth through 12 months postpartum. Making peer services available to more women, especially in communities with low initiation and duration, could improve maternal and child health in Minnesota. [ABSTRACT FROM AUTHOR]

The considerable number of families served continues to place systemic challenges on the child welfare system. Jurisdictions are turning to new strategies to increase family engagement in services and to leverage taxed or limited resources. Signs of Safety® is a strengths-based and safety-focused approach to child protection work that is grounded in partnership and collaboration. This exploratory pilot study with a referred participant sample used interviews with 26 parents and 32 safety network members to explore respondents' perceptions and use of a safety plan and safety network, core components of the Signs of Safety framework. Findings from this pilot investigation include insights about how safety plans and safety networks are established, how they function, and opportunities for enhancing their use with families with the goal of providing supports that increase the likelihood of continued safety for children after case closure. Preliminary results also suggest these tools may contribute to reduced re-reports to child protection. [ABSTRACT FROM AUTHOR]

Mental illness is more prevalent among adult inmates in Minnesota county jails than nationally. All 78 Minnesota county jails were surveyed about their continuum-of-care procedures to help ensure that inmates who have mental illness continue to receive psychiatric medications after release. Of the 28 county jails responding to the survey (36%), most estimated that greater than 40% of their inmates receive medication for mental illness during incarceration. But while 89% of respondents reported that inmates are frequently taking medication(s) to treat mental illness at release, prerelease planning for these inmates was rarely undertaken. Few Minnesota jails reported having continuum-of-care procedures in place for inmates who have mental illness when these inmates are released back into the community. Jail staff desire greater collaboration between jails, human services agencies, and community mental health providers to help support discharge planning and enhance the continuum of care for inmates who have mental illness. [ABSTRACT FROM AUTHOR]

ABSTRACT BACKGROUND Hennepin County partnered with schools to implement lunchroom strategies to encourage fruit and vegetable consumption. An in-depth evaluation measured changes in consumption following implementation of encouragement strategies including slicing apples and attractive labels. METHODS A pre-post prospective evaluation measured changes in average fruit and vegetable consumption at 2 elementary schools. The plate waste method was used to weigh individual waste. To measure consumption, 373 students were matched pre/post. Additional measures included change in fruit and vegetable selection, change in whole servings consumed and apple consumption. RESULTS Average fruit consumption increased by 3.0 g (p = .09), average vegetable consumption increased by 1.1 g (p = .27), neither significantly. The number of students selecting fruit significantly increased (p = .02), while the number taking vegetables increased, but not significantly (p = .28). The number of students consuming an entire serving of fruit (p = .15) or vegetables (p = .45) both increased but not significantly. Apple consumption more than doubled at one school. CONCLUSIONS Implementing lunchroom changes can increase the number of students selecting fruit, and changes including slicing can increase consumption of apples. Additional strategies are needed to increase vegetable selection and fruit and vegetable consumption. [ABSTRACT FROM AUTHOR]

BACKGROUND: Coarse particulate matter (PM10-2.5) is primarily mechanically generated and includes crustal material, brake and tire wear, and biological particles. PM10-2.5 is associated with pulmonary disease, which can lead to right ventricular (RV) dysfunction. Although RV characteristics have been associated with combustion-related pollutants, relationships with PM10-2.5 remain unknown. OBJECTIVES: To quantify cross-sectional associations between RV dysfunction and PM10-2.5 mass and components among older adults and susceptible populations. METHODS: We used baseline cardiac magnetic resonance images from 1,490 participants (45-84 y old) from the Multi-Ethnic Study of Atherosclerosis and assigned 5-y residential concentrations of PM10-2.5 mass, copper, zinc, phosphorus, silicon, and endotoxin, using land-use regression models. We quantified associations with RV mass, end-diastolic volume, and ejection fraction after control for risk factors and copollutants using linear regression. We further examined personal susceptibility. RESULTS: We found positive associations of RV mass and, to a lesser extent, end diastolic volume with PM10-2.5 mass among susceptible populations including smokers and persons with emphysema. After adjustment for copollutants, an interquartile range increase in PM10-2.5 mass (2:2 μg/m³) was associated with 0:5 g (95% CI: 0.0, 1.0), 0:9 g (95% CI: 0.1, 1.7), and 1:4 g (95% CI: 0.4, 2.5) larger RV mass among former smokers, current smokers, and persons with emphysema, respectively. No associations were found with healthy individuals or with ejection fraction. CONCLUSIONS: Alterations to RV structure may represent a mechanism by which long-term PM10-2.5 exposure increases risks for adverse respiratory and cardiovascular outcomes, especially among certain susceptible populations. [ABSTRACT FROM AUTHOR]

Immigrants experience an escalation of negative health behaviors after arrival to the United States. Negative mood is associated with poorer health behaviors in the general population; however, this relationship is understudied in immigrant populations. Adolescent (n = 81) and adult (n = 70) participants completed a health behavior survey for immigrant families using a community-based participatory research approach. Data was collected for mood, nutrition, and physical activity. Adolescents with positive mood drank less regular soda, and demonstrated more minutes, higher levels, and greater social support for physical activity (all ps < .05). Adults with positive mood reported more snacking on fruits/vegetables, greater self-efficacy for physical activity, and better physical well-being (all ps < .05). Negative mood was associated with low physical activity level and poor nutritional habits in adolescent and adult immigrants. Designing community-based programs offering strategies for mood management and healthy lifestyle change may be efficacious for immigrant populations. [ABSTRACT FROM AUTHOR]

Clergy members suffering from burnout face both personal and professional complications. This study assessed occupational burnout and stress coping mechanisms among ministers affiliated with the Assemblies of God, a denomination that has received little attention in previous burnout-related studies. A cross-sectional design was employed using two instruments with acceptable psychometric properties. Approximately 65 % of those surveyed were either suffering from burnout or on the verge of burnout. Statistical differences in coping mechanism use were found between those who were and were not experiencing some level of burnout. The results of this study add to the existing understanding of occupational burnout among clergy members and ways in which burnout may be alleviated. [ABSTRACT FROM AUTHOR]

BACKGROUND: Providing infrastructure and land uses to encourage active travel (i.e., bicycling and walking) are promising strategies for designing health-promoting cities. Population-level exposure to air pollution during active travel is understudied. OBJECTIVES: Our goals were a) to investigate population-level patterns in exposure during active travel, based on spatial estimates of bicycle traffic, pedestrian traffic, and particulate concentrations; and b) to assess how those exposure patterns are associated with the built environment. METHODS: We employed facility-demand models (active travel) and land use regression models (particulate concentrations) to estimate block-level (n = 13,604) exposure during rush-hour (1600-1800 hours) in Minneapolis, Minnesota. We used the model-derived estimates to identify land use patterns and characteristics of the street network that are health promoting. We also assessed how exposure is correlated with indicators of health disparities (e.g., household income, proportion of nonwhite residents). Our work uses population-level rates of active travel (i.e., traffic flows) rather than the probability of walking or biking (i.e., "walkability" or "bikeability") to assess exposure. RESULTS: Active travel often occurs on high-traffic streets or near activity centers where particulate concentrations are highest (i.e., 20-42% of active travel occurs on blocks with high population-level exposure). Only 2-3% of blocks (3-8% of total active travel) are "sweet spots" (i.e., high active travel, low particulate concentrations); sweet spots are located a) near but slightly removed from the city-center or b) on off-street trails. We identified 1,721 blocks (~ 20% of local roads) where shifting active travel from high-traffic roads to adjacent low-traffic roads would reduce exposure by ~ 15%. Active travel is correlated with population density, land use mix, open space, and retail area; particulate concentrations were mostly unchanged with land use. CONCLUSIONS: Public health officials and urban planners may use our findings to promote healthy transportation choices. When designing health-promoting cities, benefits (physical activity) as well as hazards (air pollution) should be evaluated. CITATION: Hankey S, Lindsey G, Marshall JD. 2017. Population-level exposure to particulate air pollution during active travel: planning for low-exposure, health-promoting cities. Environ Health Perspect 125:527-534; http://dx.doi.org/10.1289/EHP442 [ABSTRACT FROM AUTHOR]

Objective: This study explored the association of stress and depression with a multidimensional sleep problems construct in a sample of 2-year college students.Participants: The sample consisted of 440 students enrolled in 2-year study from Fall 2011 to Fall 2013.Methods: Participants in an obesity prevention study completed surveys assessing sleep, stress, and depression at baseline, 4, 12, and 24 months. Multilevel models predicting sleep problems were conducted to distinguish episodic from chronic reports of stress and depression.Results: Participants were primarily women (68%), white (73%), young adults (Mage = 22.8), with an average of 8.4 hours of sleep per night. Neither stress nor depression was predictive of sleep quantity; however, they were predictive of sleep quality.Conclusions: Results show that sleep quality rather than sleep quantity may be the greater health concern for young adults, suggesting that intervention programs targeting depression, stress management, and healthy sleep patterns are warranted. [ABSTRACT FROM PUBLISHER]

Background: We studied the effect of key development and expansion of an off-road multipurpose trail system in Minneapolis, Minnesota between 2000 and 2007 to understand whether infrastructure investments are associated with increases in commuting by bicycle. Methods: We used repeated measures regression on tract-level (N = 116 tracts) data to examine changes in bicycle commuting between 2000 and 2008-2012. We investigated: 1) trail proximity measured as distance from the trail system and 2) trail potential use measured as the proportion of commuting trips to destinations that might traverse the trail system. All analyses (performed 2015-2016) adjusted for tract-level sociodemographic covariates and contemporaneous cycling infrastructure changes (e.g., bicycle lanes). Results: Tracts that were both closer to the new trail system and had a higher proportion of trips to destinations across the trail system experienced greater 10-year increases in commuting by bicycle. Conclusions: Proximity to off-road infrastructure and travel patterns are relevant to increased bicycle commuting, an important contributor to overall physical activity. Municipal investment in bicycle facilities, especially off-road trails that connect a city's population and its employment centers, is likely to lead to increases in commuting by bicycle. [ABSTRACT FROM AUTHOR]

Previous research has shown that continuous rating scales can be used to assess phonetic detail in children’s productions, and could potentially be used to detect covert contrasts. Two experiments examined whether continuous rating scales have the additional benefit of being less susceptible to task-related biasing than categorical phonetic transcriptions. In both experiments, judgements of children’s productions of /s/ and /θ/ were interleaved with two types of rating tasks designed to induce bias: continuous judgements of a parameter whose variation is itself relatively more continuous (gender typicality of their speech) in one biasing condition, and categorical judgements of a parameter that is relatively less continuous (the vowel they produced) in the other biasing condition. One experiment elicited continuous judgements of /s/ and /θ/ productions, while the other elicited categorical judgements. The results of Experiment 1 showed that the influence of acoustic characteristics on continuous judgements of /s/ and /θ/ was stable across biasing conditions. In contrast, the results of Experiment 2 showed that the influence of acoustic characteristics on categorical judgements of /s/ and /θ/differed systematically across biasing conditions. These results suggest that continuous judgements are psychometrically superior to categorical judgements, as they are more resistant to task-related bias. [ABSTRACT FROM PUBLISHER]

Aims To compare the use of alternative nicotine products, smoking behavior and tobacco biomarker exposure in smokers unwilling to quit who were assigned randomly to normal nicotine content (NNC) cigarettes or very low nicotine content (VLNC) cigarettes. Design Randomized, parallel-arm 8-week study with assignment to VLNC (VLNC 1, n = 53) or NNC (NNC, n = 27) with access to non-cigarette combusted and non-combusted tobacco/nicotine products or to VLNC with access to only non-combusted products (VLNC2, n = 56). Setting Clinics in Minnesota, USA. Participants Smokers uninterested in quitting smoking with a mean [± standard deviation (SD)] age of 44 (± 14) years and smoking 16 (± seven) cigarettes/day; 51% female, 72% white. Measurements During the experimental period, the measures taken included: rate of alternative products used, amount of and abstinence from combusted tobacco used and tobacco exposure biomarkers. Findings There were higher rates of non-combusted alternative tobacco/nicotine product use in both VLNC conditions versus the NNC condition [rate ratio (RR) = 2.18, 95% confidence interval (CI) = 1.94, 2.46 and RR = 1.64, 95% CI = 1.46, 1.85, respectively] and in VLNC1 versus VLNC2 condition (RR = 1.33, 95% CI = 1.23, 1.44), accompanied by reduced biomarkers of exposure primarily in VLNC2 condition compared to NNC condition ( Ps < 0.05). Fewer combusted products were smoked at almost all visits ( Ps ≤ 0.02) and there were higher rates of abstinence for both VLNC conditions compared with the NNC condition (VLNC1 versus NNC: RR = 9.96, 95% CI = 5.01, 19.81; VLNC2 versus NNC: RR = 11.23, 95% CI = 5.74, 21.97). Conclusion The offer of, and instructions to use, reduced nicotine content cigarettes during an 8-week period led to greater use of alternative tobacco/nicotine products compared with continued use of normal nicotine cigarettes and also reductions in smoking rates. [ABSTRACT FROM AUTHOR]

Background. The importance of health professionals discussing health behaviors with patients is emphasized in Healthy People 2020, the national health objectives established by the US Department of Health and Human Services. Many physical therapists do not routinely discuss health behaviors with their patients. One reason may be uncertainty about how these discussions might be perceived by patients. Objective. The primary purpose of this study was to determine patients' opinions regarding physical therapists discussing the topics of physical activity, smoking, fruit and vegetable consumption, and maintaining a healthy weight during clinical visits. A secondary purpose was to determine whether patients believe that physical therapists should be role models for these behaviors. Design. This was a descriptive cross-sectional survey. Methods. Patients were surveyed at 8 outpatient clinics in Michigan and Minnesota. A written questionnaire collected information about the participants' health behaviors, their opinions about physical therapists discussing their health behaviors during clinical visits, and their opinions about physical therapists role-modeling healthy behaviors. Results. The survey response rate was 45.6%. A total of 230 patients participated. Most participants agreed that physical therapists should speak to them about physical activity (91.3%), maintaining a healthy weight (73%), and abstaining from smoking (51.3%). Fewer participants agreed that physical therapists should advise them about fruit and vegetable consumption (32.1%). The majority of participants agreed that physical therapists should be role models for engaging in regular physical activity (83.4%), maintaining a healthy weight (71.7%), and abstaining from smoking (63.9%). Limitations. Limitations of this study include the potential for response bias and limited generalizability. Conclusions. Most participants believed it is appropriate for physical therapists to speak with them about and be role models for the behaviors of physical activity, maintaining a healthy weight, and abstaining from smoking. Physical therapists have the opportunity to support the goals of Healthy People 2020 by discussing health behaviors with their patients. [ABSTRACT FROM AUTHOR]

Background Neurobehavioral consequences of heavy prenatal alcohol exposure are well documented; however, the role of age or sex in these effects has not been studied. The current study examined the effects of prenatal alcohol exposure, sex, and age on neurobehavioral functioning in children. Methods Subjects were 407 youth with prenatal alcohol exposure ( n = 192) and controls ( n = 215). Two age groups (child [5 to 7 years] or adolescent [10 to 16 years]) and both sexes were included. All subjects completed standardized neuropsychological testing, and caregivers completed parent-report measures of psychopathology and adaptive behavior. Neuropsychological functioning, psychopathology, and adaptive behavior were analyzed with separate 2 (exposure history) × 2 (sex) × 2 (age) multivariate analyses of variance (MANOVAs). Significant effects were followed by univariate analyses. Results No 3-way or 2-way interactions were significant. The main effect of group was significant in all 3 MANOVAs, with the control group performing better than the alcohol-exposed group on all measures. The main effect of age was significant for neuropsychological performance and adaptive functioning across exposure groups with younger children performing better than older children on 3 measures (language, communication, socialization). Older children performed better than younger children on a different language measure. The main effect of sex was significant for neuropsychological performance and psychopathology; across exposure groups, males had stronger language and visual spatial scores and fewer somatic complaints than females. Conclusions Prenatal alcohol exposure resulted in impaired neuropsychological and behavioral functioning. Although adolescents with prenatal alcohol exposure may perform more poorly than younger exposed children, the same was true for nonexposed children. Thus, these cross-sectional data indicate that the developmental trajectory for neuropsychological and behavioral performance is not altered by prenatal alcohol exposure, but rather, deficits are consistent across the 2 age groups tested. Similarly, observed sex differences on specific measures were consistent across the groups and do not support sexually dimorphic effects in these domains. [ABSTRACT FROM AUTHOR]

The current study presents results from an autism spectrum disorder (ASD) public health surveillance project conducted in Minneapolis. The study was designed to compare ASD prevalence in Somali children (ages 7-9) to that of non-Somali children. The study adapted methodology used by the Centers for Disease Control and Prevention's Autism and Developmental Disabilities Monitoring Network. Results indicated that Somali (1 in 32) and White (1 in 36) children were about equally likely to be identified with ASD, but more likely to be identified with ASD than Black and Hispanic children. Somali children with ASD were significantly more likely to have an intellectual disability than children with ASD in all other racial and ethnic groups. [ABSTRACT FROM AUTHOR]

Purpose: Prior studies have suggested that cochleovestibular malformation (CM) may have an influence on surgical and auditory outcomes in pediatric cochlear implant (CI) recipients. The present study aimed to use retrospective data to explore surgical and auditory outcomes in pediatric CI recipients with CM compared to pediatric CI recipients with normal anatomy (NA) through the use of a secure, web-based database. Method: This study was completed through retrospective chart review using a database of pediatric patients with hearing loss (N=199) seen at a multidisciplinary clinic. The online database was populated with clinical data including imaging results, surgical and sensory device information, patient variables (e.g., age at onset of hearing loss, age at cochlear implantation), and aided speech perception results. Results: A higher rate of surgical complications was experienced by the group with CM (39%) than the group with NA (9%). No significant differences were noted between groups over time on performance of most speech perception tests. However, a difference between groups was observed when PB-K words (Haskins, 1949) were assessed over time, with children with NA performing 21% better on average than children with CM. Conclusion: Greater variability exists in performance outcomes for pediatric CI patients with CM than for those with normal inner ear anatomy. Implementation of a pediatric minimum speech test battery would improve the uniformity of test administration with and across programs, allowing for comparison of outcomes across CI centers. [ABSTRACT FROM AUTHOR]

OBJECTIVE To examine the traditional diet-heart hypothesis through recovery and analysis of previously unpublished data from the Minnesota Coronary Experiment (MCE) and to put findings in the context of existing diet-heart randomized controlled trials through a systematic review and meta-analysis. DESIGN The MCE (1968-73) is a double blind randomized controlled trial designed to test whether replacement of saturated fat with vegetable oil rich in linoleic acid reduces coronary heart disease and death by lowering serum cholesterol. Recovered MCE unpublished documents and raw data were analyzed according to hypotheses prespecified by original investigators. Further, a systematic review and meta-analyses of randomized controlled trials that lowered serum cholesterol by providing vegetable oil rich in linoleic acid in place of saturated fat without confounding by concomitant interventions was conducted. SETTING One nursing home and six state mental hospitals in Minnesota, United States. PARTICIPANTS Unpublished documents with completed analyses for the randomized cohort of 9423 women and men aged 20-97; longitudinal data on serum cholesterol for the 2355 participants exposed to the study diets for a year or more; 149 completed autopsy files. INTERVENTIONS Serum cholesterol lowering diet that replaced saturated fat with linoleic acid (from corn oil and corn oil polyunsaturated margarine). Control diet was high in saturated fat from animal fats, common margarines, and shortenings. MAIN OUTCOME MEASURES Death from all causes; association between changes in serum cholesterol and death; and coronary atherosclerosis and myocardial infarcts detected at autopsy. RESULTS The intervention group had significant reduction in serum cholesterol compared with controls (mean change from baseline-13.8% y-1.0%; P<0.001). Kaplan Meier graphs showed no mortality benefit for the intervention group in the full randomized cohort or for any prespecified subgroup. There was a 22% higher risk of death for each 30 mg/dL (0.78 mmol/L) reduction in serum cholesterol in covariate adjusted Cox regression models (hazard ratio 1.22, 95% confidence interval 1.14 to 1.32; P<0.001). There was no evidence of benefit in the intervention group for coronary atherosclerosis or myocardial infarcts. Systematic review identified five randomized controlled trials for inclusion (n=10 808). In meta-analyses, these cholesterol lowering interventions showed no evidence of benefit on mortality from coronary heart disease (1.13, 0.83 to 1.54) or all cause mortality (1.07, 0.90 to 1.27). CONCLUSIONS Available evidence from randomized controlled trials shows that replacement of saturated fat in the diet with linoleic acid effectively lowers serum cholesterol but does not support the hypothesis that this translates to a lower risk of death from coronary heart disease or all causes. Findings from the Minnesota Coronary Experiment add to growing evidence that incomplete publication has contributed to overestimation of the benefits of replacing saturated fat with vegetable oils rich in linoleic acid. [ABSTRACT FROM AUTHOR]

Dysrhythmias and Death in BiMVP Introduction Bileaflet mitral valve prolapse (BiMVP) is common among survivors of otherwise unexplained sudden cardiac death, but prognostic implications of BiMVP are unknown. This study evaluated whether patients with BiMVP are at higher risk for ventricular dysrhythmias, ICD placement, or death compared to controls with either single-leaflet mitral valve prolapse (SiMVP) or no mitral valve prolapse (MVP). Methods and Results This retrospective, matched cohort study included 18,786 patients who underwent echocardiography at Mayo Clinic between June 1990 and September 2014. The study included three cohorts: BiMVP, SiMVP, and controls without MVP. We assessed rates of ventricular dysrhythmias, ICD placement, and all-cause mortality between groups. BiMVP was associated with higher rates of ventricular tachycardia compared to SiMVP and controls (adjusted HR 1.48 [1.14-1.92], P = 0.003 and 1.40 [1.04-1.88], P = 0.026, respectively); however, there were no statistically significant differences in rates of ventricular fibrillation/cardiac arrest or ICD placement between groups. BiMVP was associated with a lower rate of all-cause mortality compared to SiMVP and controls (adjusted HR 0.86 [0.79-0.94], P = 0.0008, and 0.55 [0.50-0.60], P < 0.0001, respectively). Conclusion Although BiMVP is associated with ventricular tachycardia, it is not associated with an increased risk of cardiac arrest/ventricular fibrillation or ICD implantation and is, paradoxically, associated with a better survival compared to SiMVP or matched controls. The findings suggest that, despite its association with ventricular tachycardia, BiMVP in the absence of other risk factors does not seem to portend a poor prognosis at the population level. [ABSTRACT FROM AUTHOR]

Weight-related outcomes were examined among high school students in Minnesota public school districts according to the quality of district wellness policies. Wellness policy strength and comprehensiveness were scored using the Wellness School Assessment Tool (WellSAT) for 325 Minnesota public school districts in 2013. The associations between WellSAT scores and district-level means of high school student responses to a statewide survey of health behaviors were examined in this ecologic study. WellSAT Total Strength and Total Comprehensiveness scores were positively associated with both student mean Body Mass Index (BMI) percentile (Strength: P = 0.018, Comprehensiveness: P = 0.031) and mean percent overweight or obese (Strength: P = 0.008, Comprehensiveness: P = 0.026), but only in districts with >50% of students eligible for Free or Reduced-Price Lunches (FRPLs), or 'high FRPL districts'. WellSAT Physical Education and Physical Activity subscale scores were also positively associated with the mean days per week students engaged in physical activity for > 60 min in high FRPL districts (Strength: P = 0.008, Comprehensiveness: P = 0.003) and in low FRPL districts (<35% eligible) for Strength score: (P = 0.027). In medium FRPL districts (35-50% eligible), Nutrition Education and Wellness Promotion Strength and Comprehensiveness subscale scores were positively associated with, respectively, daily servings of vegetables (P = 0.037) and fruit (P = 0.027); and WellSAT Total scores were positively associated with daily vegetable servings (Strength: P = 0.037, Comprehensiveness: P = 0.012). Administrators of economically disadvantaged school districts with a higher percentage of overweight students may be recognizing the need for stronger wellness policies and the specific importance of implementing policies pertaining to physical activity as a means to improve student health. [ABSTRACT FROM AUTHOR]