Trends and disparities among diabetes-complicated births in Minnesota, 1993-2003.

We used Minnesota birth certificate data from 1993-2003 to test 2 hypotheses: rates of diabetes-complicated pregnancy are increasing, and disparities between more and less socially advantaged groups are widening. Significant increases occurred in rates (per 1000 live births) of prepregnancy and gestational diabetes mellitus (from 2.6 to 4.9 and 25.6 to 34.8, respectively). Increases were significant in all demographic groups except gestational diabetes among American Indian mothers, and disparities worsened among all groups. Targeted interventions and surveillance improvements are needed.

A media campaign to promote pneumococcal vaccinations: is a telephone survey an effective evaluation strategy?

PURPOSE: Media campaigns are used to achieve public health goals but few studies have documented whether the goals were met. METHODS: Two communities received community-wide efforts to increase the pneumococcal polysaccharide vaccine (PPV) rate in defined pneumococcal disease-risk groups. One community also received a media campaign consisting of television and newspaper advertisements. A random-digit-dial telephone survey was conducted before and after the media campaign in both of the designated media markets. In addition to direct mailings to a sample of Medicare beneficiaries whose Medicare billing records did not indicate a PPV billing claim after 1991, community-wide campaigns consisting of table tents, brochures, flyers, and posters occurred in both markets. A 29-day television campaign and a 5-week newspaper campaign occurred in one of the markets. RESULTS: We were unable to detect a significant effect of the media campaign on either PPV awareness or self-reported receipt of pneumococcal vaccine. CONCLUSION: While it is important to evaluate community health intervention efforts, evaluations can be very difficult. Because of financial and other limitations, most feasible evaluation methods will not have the power to detect changes attributable to the intervention nor to provide confidence that there was no important change.

Increasing rate of diabetes in pregnancy among American Indian and white mothers in Montana and North Dakota, 1989-2000.

OBJECTIVES: The purpose of this study was to assess trends in diabetes in pregnancy in American Indian and whites mothers in Montana and North Dakota. METHODS: Montana and North Dakota birth records were utilized to assess trends in any diabetes in pregnancy in American Indians and whites from 1989 to 2000. RESULTS: From 1989 through 2000, there were 133,991 and 102,232 births in Montana and North Dakota, respectively. The majority of mothers were American Indian (11%) or white (87%). The rate of any diabetes in pregnancy increased significantly in Montana Indian (3.1-4.1%, p = 0.04) and white mothers (1.8-2.6%, p < 0.001) from 1989-1991 to 1998-2000. The rate also increased significantly in white North Dakota mothers (1.6-3.2%, p < 0.001), but the increase in rate for Indian mothers in North Dakota did not reach statistical significance (3.8-4.8%, p = 0.06) during this time period. In each time period, Montana and North Dakota Indian mothers were more likely than white mothers to have any diabetes in pregnancy. CONCLUSIONS: The rate of diabetes in pregnancy has increased in American Indian and white mothers. Thus public health programs are now facing an increasing number of women with a history of GDM at future risk of type 2 diabetes and an increasing number of offspring of diabetic pregnancies at risk for becoming overweight and developing type 2 diabetes at a young age.