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Childhood sexual abuse (CSA) is common and is associated with both mental and physical health problems in adulthood. Using data from an age- and sex-stratified population survey of 600 Olmsted County, Minnesota, residents, a Sexual Abuse Severity Score was developed. The abuse characteristics of 156 CSA respondents were associated with self-reported trauma, somatization, and alcohol use. Characteristics included age of first sexual abuse, more than one perpetrator, degree of coercion, severity of abuse (i.e., attempted intercourse is more severe than fondling), and the number of occurrences. This is one of the few reports to develop a risk summary that quantifies the severity of CSA. (Contains 3 tables.)

Background: With the popularity of global health among medical students and residents, family medicine (FM) residencies are developing pathways in global health. Curriculum based on Accreditation Council for Graduate Medical Education (ACGME) competencies adds rigor to the efforts.Description: We describe the adaptation of a comprehensive pediatric global health curriculum based on ACGME competencies for family medicine. The curriculum maps out goals, objectives, curricular elements, and evaluation modalities for each of the six competencies (medical knowledge, patient care, practice-based learning, professionalism, communication, and systems-based practice). A literature review, followed by an iterative process, guided the expansion of the pediatric curriculum and the prioritization of domains for FM. Input was sought from FM global health faculty at our 8 residencies, affiliated community faculty, and international health experts from across the United States who attended our workshop at a national FM global health meeting. The final product includes comprehensive competency-based curriculum, open-source resources, and evaluation modalities. The goals and objectives pertinent to all FM residents, and those specific to global health pathway residents and fellows, are outlined.Evaluation: The limiting and enabling factors of the curriculum implementation are presented.Conclusions: This global family medicine curriculum has added structure and rigor to our international electives in the department at the University of Minnesota. The competency-based curriculum is in the early stages of implementation and evaluation. It has already strengthened components of the residency learning experience for all residents. A robust evaluation is needed and requires monitoring pathway graduates and their career choices into the future. The curriculum is available for adoption by other FM residencies. [ABSTRACT FROM AUTHOR]

Background: Medical schools worldwide are challenged to address the rural primary care workforce shortage by creating community-engaged curricula to nurture student interest in rural practice. Aim: To examine the personal characteristics of six consecutive rural longitudinal integrated clerkship student cohorts to understand whom the programs attract and select and thus inform the development of such programs. Method: A cross-sectional cohort design was used. Six cohorts (2007-2012) completed a survey on demographics and factors that influenced their choice of rural primary care. The Temperament and Character Inventory was used to measure personality. Analysis was mainly descriptive. Where appropriate univariate analysis compared variables between groups. Results: Sample size was 205 with the majority female (61%), between 25 and 29 years (64%), single (60%) and lived longest in rural communities with populations less than 20,000 (60%). Rural lifestyle, background and desire to work in underserved areas were noted to impact rural medicine interest. Professional satisfaction, personal and professional goals and family needs had the highest impact on career decisions, and financial concerns lowest. Conclusion: The stability of students' personal characteristics across cohorts and the workforce outcomes of this program suggest the recruitment process successfully nurtures students who will fit well into future rural practice. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study was to identify the organizational factors that influence electronic health information exchange (HIE) by medical group practices in rural areas. Methods: A purposive sample of 8 small medical group practices in 3 experimental HIE regions were interviewed to determine the extent of clinical information exchange with other health care providers and to identify the factors influencing those patterns. Findings: HIE was found to be largely limited to exchanging immunization data through the state health department and exchanging clinical information within owned provider systems. None of the clinics directly exchange clinical information with non-owned clinics or hospitals. Conclusions: While regional HIE networks may be a laudable goal, progress is slow and significant technical, political, and financial obstacles remain. Limiting factors include data protection concerns, competition among providers, costs, and lack of compatible electronic health record (EHR) systems. [ABSTRACT FROM AUTHOR]

The article highlights the decrease in the number of pressure ulcers reported to the State of Minnesota after a pressure ulcer prevention program was implemented at Allina Hospitals & Clinics. It mentions the program was cochaired by a certified wound, ostomy, and continence nurse (CWOCN) and a clinical nurse specialist. Details pertaining to the implementation of the program, which include prevention foundational strategies, standardized education, and nutritional intervention are also discussed. The article mentions the provider awareness campaign "Skin Day" was conducted. A program evaluation and the conclusion of the study are also presented.

Examines the distribution of Masked Shrews and Prairie Shrews in Minnesota and examines the possibility of intergradation. Analysis of mitochondrial DNA sequences for shrews; Extent of introgression between the two species; Assessment of the use of morphological characteristics to distinguish the two species.

Presents an interview with the DaPonte String Quartet, one of the convention artists for the Music Teachers National Association National Convention to be held in Minneapolis, Minnesota in March 2000. Information on their Rural Residency Grant in Damariscotta, Maine; Description of their typical day; Comparison of a life of a classical musician in Maine with a musician working in a big city; How they plan their repertoire.

Abstract: The white-tailed deer (Odocoileus virginianus) is considered one of the most important wildlife reservoirs of Neospora caninum and Toxoplasma gondii in the US. Sera from white-tailed deer from Minnesota and Iowa were tested for antibodies to N. caninum by four serologic tests including the indirect fluorescent antibody (IFA) test (cut-off 1:25), Neospora caninum agglutination test (cut-off 1:25), an enzyme-linked immunoabsorbent assay, and Western blot (WB). Sera were also tested for antibodies to T. gondii using the modified agglutination test (cut-off 1:25). Of 62 adult deer from Minnesota antibodies to T. gondii were found in 20 (32.2%), N. caninum in 44 (71%), with dual infections in 18 deer. Of 170 (73 fawns, 9 yearlings, 88 adults) deer from Iowa, T. gondii antibodies were present in 91 (53.5%) with 37.0, 55.6 and 67.0% seropositivity in fawns, yearlings, and adults, respectively. Antibodies to N. caninum were found in 150 of 170 (88.2%) by any of the 3 tests (99 by Western blots, 135 by ELISA, 106 by IFA, and 118 by NAT). Dual infections with T. gondii and N. caninum were detected in 47 deer. Very high (84.9%) seropositivity of N. caninum in fawns suggests high rate of congenital transmission of the parasite. Seropositivity in each test at different titers is discussed. [Copyright &y& Elsevier]

Background: Four practice-based research networks (PBRNs) participated in a study to determine whether networks could increase dissemination, implementation, and diffusion of evidence-based treatment guidelines for chronic kidney disease by leveraging early adopter practices., Methods: Motivated practices from four PBRNs received baseline and periodic performance feedback, academic detailing, and weekly practice facilitation for 6 months during wave I of the study. Each wave I practice then recruited two additional practices (wave II), which received performance feedback and academic detailing and participated in monthly local learning collaboratives led by the wave I clinicians. They received only monthly practice facilitation. The primary outcomes were adherence to primary care-relevant process-of-care recommendations from the National Kidney Foundation Kidney Disease Outcomes Quality Initiative Guidelines. Performance was determined retrospectively by medical records abstraction. Practice priority, change capacity, and care process content were measured before and after the interventions., Results: Following the intervention, wave I practices increased the use of ACEIs/ARBs, discontinuation of NSAIDs, testing for anemia, and testing and/or treatment for vitamin D deficiency. Most were able to recruit two additional practices for wave II, and wave II practices also increased their use of ACEIs/ARBs and testing and/or treatment of vitamin D deficiency., Conclusions: With some assistance, early adopter practices can facilitate the diffusion of evidence-based approaches to other practices. PBRNs are well-positioned to replicate this process for other evidence-based innovations.

Purpose: Rural physicians wrestle with professional boundary issues routinely in everyday interactions, and their situation differs from the experience of their urban colleagues. Medical students receive limited exposure to professional boundary management in preclinical training. Increasingly, schools are implementing rural longitudinal clinical clerkships which expose students to rural boundary setting. This qualitative study explored the management of professional boundaries integral to rural practice and how this management may differ from their urban colleagues., Method: Semistructured interviews were conducted in 2010 with 12 rural physicians across Minnesota exploring their perceptions of professionalism in rural practice. A social constructivist approach to grounded theory was used to analyze the data., Results: Five primary themes regarding rural professionalism emerged from the data: centrality of care, rural influences on choice, individualization of boundary setting, advantages of dual relationships, and disadvantages of them. These themes served to illustrate rural boundary management., Conclusions: This study's findings indicate that rural physicians are routinely confronted with professional boundary issues in everyday situations, and these circumstances do not always reflect those of their urban colleagues. Given the increase in longitudinal immersion clinical clerkship programs to nurture student interest in future rural practice, acknowledgment and acceptance of the nuances of dual relationships and boundary setting in different clinical learning contexts are vital to help students identify their personal needs for privacy and be better prepared to negotiate the realities of rural practice. These findings may inform future medical education initiatives on professional boundary setting as an aspect of professionalism.

Purpose: Globally competent pediatricians are in demand because of the increasing numbers of children from immigrant families living in the United States and the shortages of health care workers in low-income countries where the majority of the worlds' children live. This study sought to better understand the educational outcomes of international electives taken by pediatric residents training in global health., Methods: Thirty-two pediatric residents who participated in an international elective as part of a global health curriculum completed reflective essays which were analyzed for themes from 2006 to 2010. During the first-order analysis, the emergent themes mapped to the Accreditation Council for Graduate Medical Education (ACGME) competencies. In response, a second-order analysis re-examined the essays with an additional researcher to support categorization consistent with the ACGME competencies., Results: More than 90% of essays described experiences related to medical knowledge, patient care and systems-based practice. More than 50% included reflections on practice-based learning and improvement, professionalism, and interpersonal and communication skills. Residents also described the impact on their personal and professional development., Conclusion: International electives can provide educational opportunities for residents to develop competency in each of the 6 ACGME domains and to reevaluate their life purpose and career goals. In addition to opportunities to increase their medical knowledge, patient care and communication skills, residents find international electives rich learning environments for systems-based practice, practice-based learning/improvement, and professionalism, domains that can be challenging to teach. These findings support the importance of international electives in global health in meeting core requirements in residency training., (Copyright © 2012 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.)

Background: Demonstrating the equivalency between the traditional metro-based clerkships within close proximity to the academic health center and the nontraditional rural preceptorships is important. The University of Minnesota has had a 9-month longitudinal rural elective for third-year medical students for 40 years, the Rural Physician Associate Program (RPAP). In the metro area, traditional students rotate through clerkships of 4 to 8 weeks in length. Both cohorts of students are evaluated in similar ways., Methods: We analyzed the test scores and demographic data for two cohorts of students: RPAP (n=201) and traditional (n=1,129) who graduated between 2004 and 2009. Tests included pre-medical school data (Medical College Admission Tests, college grade point averages) as well as National Board of Medical Examiners subject examinations (shelf), US Medical Licensing Examination Step One and Two (Clinical Knowledge and Clinical Skills), and an Objective Structured Clinical Examination (OSCE). Scores were analyzed using descriptive/comparative statistics for the two groups of students., Results: For the most part, RPAP students performed similarly to students in the traditional metro-based curriculum on the standard educational outcome metrics. On the obstetrics shelf, while a similar proportion of the RPAP students passed, they scored statistically significantly lower (traditional: median 72 (range 50-98) versus RPAP: 71 (51-89)., Discussion: This study is the largest cohort demonstrating equivalency between students taking a rural longitudinal clerkship and their metro-trained colleagues.

Background: Professionalism is now an explicit part of the medical school curricula., Aim: To examine the components that are part of developing professionalism during the Rural Physician Associate Program (RPAP) experience, a 9-month rotation in a rural community during the third year of medical school., Methods: Two researchers analysed 3 years of essays for themes. IRB approval was obtained., Results: Themes were organized using Van de Camp's model of professionalism. Students described how patients taught them about illnesses, the affects on their lives and the lives of their families. Preceptors role-modelled how to relate to patients with compassion and respect (Professionalism Towards the Patient). As a member of the health care team, clinic and hospital staff taught students how to be a good team member (Towards Other Health Care Professionals). Shadowing preceptors in their roles as physicians and community members, students learned about their responsibilities to the community (Towards the Public). Multiple opportunities for self-evaluation and reflection taught students to know themselves and find balance between work responsibilities and their personal lives (Towards Oneself)., Conclusion: The RPAP appears to create a supportive learning environment that incorporates psychological safety, appreciation of differences, openness to new ideas and time for reflection - an ideal environment for developing professionalism.

Acute stroke is a leading cause of morbidity and mortality. Both time-sensitive treatment and telemedicine are being used to improve the care of stroke patients in rural areas. This article highlights the case of a 62-year-old male patient with sudden onset of right-sided hemiparesis and a family history of vascular disease and how he was treated at a rural hospital that was connected by telemedicine technology to an urban tertiary care center. It also reviews protocols for acute treatment of stroke and systems of stroke care in rural areas.

Until recently, domestic violence was considered a criminal justice or social service problem. However, physicians see victims in emergency settings and clinics with complaints and symptoms that go beyond physical injuries. A study by a Minnesota health plan shows that, on average, a victim of domestic violence costs the health care system $1,434 more per year than a nonvictim. This article discusses the prevalence of domestic violence and the variety of presentations. Guidelines for screening, what to do with a positive response, when to call the police, and how to document and code are reviewed, as are issues unique to older victims of domestic violence.

Managed care organizations (MCOs) joined local and state public health agencies in a pilot effort to improve hepatitis B immunization rates of adolescents in an urban and a suburban/rural school district. The pilot also explored issues inherent in public and private collaboration on population health improvement. Local public health agencies provided links to schools in their communities, took the lead in implementing school-based immunization programs, and provided health education materials. MCOs contributed financial support necessary for the project. The final cost per fully vaccinated student, not taking into account the work group's planning and coordination time, was little more than the catalog price of the vaccine alone. Managed care organizations face challenges that complicate their participation and funding of school-based vaccinations: 1) Limited data on health plans of participating students complicate allocation of costs to each MCO; 2) Double-paying occurs for MCOs paying clinics a monthly, per-member rate that already includes adolescent immunizations; 3) When schools provide adolescent immunizations, MCOs lose the "hook" that draws adolescents to clinics for comprehensive health services. When self-consenting is permitted, schools can achieve a high consent and completion rates for multi-dose adolescent immunizations such as hepatitis B. At the same time, MCOs have the responsibility to provide members with comprehensive care and should continue to examine both internal modifications and external partnerships as opportunities to improve their services to adolescents.