Relationship of workers' compensation status and duration of preoperative carpal tunnel symptoms.

Carpal tunnel syndrome (CTS) is one of the most common work-related injuries and a leading cause of work disability. We studied patients from a single community who had carpal tunnel releases (CTRs), comparing duration of preoperative symptoms and severity of nerve dysfunction among workers compensation and nonworkers compensation recipients. Included in the study were 131 patients who had a total of 187 primary CTRs done by a single surgeon. Duration of preoperative symptoms was significantly longer for nonworkers compensation patients than for workers compensation patients (p < 0.01). A smaller proportion of workers compensation patients had severe electromyography (EMG) findings (p = 0.04), and a larger portion had borderline EMG findings. People with work-related CTS appear to receive surgical treatment for CTS earlier than people whose CTS is not related to work covered under workers compensation laws.

The estimated cost of school scoliosis screening.

STUDY DESIGN: This is a population-based, longitudinal retrospective study of one community's school-based scoliosis screening program. OBJECTIVE: To report the estimated costs of mass school-based screening for scoliosis. SUMMARY OF BACKGROUND DATA: School scoliosis screening has been reported to cost from as little as $0. 06 to as much as $194 per child. The lower estimate considered only the cost to the school, and the higher estimate defined all children with curves of 5 degrees or more as cases. METHODS: School scoliosis screening results were linked with the medical and chiropractic care records of all referred children to identify outcomes and scoliosis-related health service utilization from Grade 5 through graduation or age 19 years. Costs are presented per child screened, per child with a spinal curve of 20 degrees or more, and per child treated for scoliosis and are based on scoliosis-related health care utilization and school costs. RESULTS: Ninety-two (4.1%) of 2197 children screened were referred for further evaluation of possible scoliosis, and 68 (74%) of those had documented evaluation for possible scoliosis. Five of the 92 children referred were treated for scoliosis by age 19. Sixty-six scoliosis-related primary care visits, 79 scoliosis-related orthopedist visits, and 79 full spine radiographs followed referral but preceded treatment. Case-finding costs for screening were $24.66 per child screened (n = 2197), $3, 386.25 per child with a curve of 20 degrees or more (n = 16) and $10, 836.00 per child treated for scoliosis (n = 5). CONCLUSION: School scoliosis screening is significantly more costly than has previously been reported.

An in-school CD-ROM asthma education program.

Computer-based education in schools is not novel. However, only a few computer games have been introduced into school-based health education programs. This study describes inclusion of an asthma education space adventure game into fourth-grade classrooms. Using the game improved asthma knowledge in the intervention classes. Children in the active participation classroom gained significantly more asthma knowledge over the observation period compared to the classroom that did not play the computer game. Knowledge gained was retained over a four-week period and the addition of physician-led talks appeared to add little to the knowledge gained. "Air Academy: The Quest for Airtopia" is an easy and successful tool for elementary grade asthma-related health education in schools.

A population-based study of school scoliosis screening.

CONTEXT: Although school-based screening programs for adolescent idiopathic scoliosis are mandated in 26 states in the United States, few program outcomes data exist regarding the effectiveness of such programs. OBJECTIVE: To determine the effectiveness of a community-based school scoliosis screening program. DESIGN, SETTING, AND PARTICIPANTS: Retrospective cohort study of children who attended kindergarten or first grade at public or private schools in Rochester, Minn, during 1979-1982. Children were followed up until age 19 years or until they left the school district. MAIN OUTCOME MEASURES: Number of children diagnosed and treated for scoliosis, based on results from scoliosis screenings performed annually in grades 5 through 9, linked to community medical records data; performance characteristics of the screening program. RESULTS: Of the 2242 children screened, 92 (4.1 %) were referred for further evaluation. Of these, 68 (74%) had documented medical or chiropractic evaluation of scoliosis. School screening identified 5 of the 9 children treated for scoliosis but resulted in referrals for another 87 children who were not treated. The cumulative incidence of diagnosed scoliosis in this population was 1.8% (95% confidence interval [CI], 1.2%-2.3%) for curves of more than 10 degrees, 1.0% (95% CI, 0.6%-1.5%) for curves of at least 20 degrees, and 0.4% (95% CI, 0.1 %-0.6%) for curves of 40 degrees or more; 0.4% (0.5% of girls and 0.3% of boys) were treated for scoliosis. The positive predictive value of the school screening program for the identification of treated scoliosis was 0.05 (95% CI, 0.048-0.052), with 448 children needed to screen to identify 1 child who subsequently received treatment. The percent positive agreement across consecutive years of screening varied from 7% to 30%. CONCLUSION: In this population, school scoliosis screening identified some children who went on to receive treatment but referred many more who did not. These data should be considered in making decisions regarding school scoliosis screening.

The impact of requiring patient authorization for use of data in medical records research.

BACKGROUND: In 1996, the Minnesota legislature passed a medical data privacy act requiring patient authorization for the use of medical records in research. Other state legislatures and Congress are considering similar legislation. The impact of this statute on a researcher's ability to obtain complete and representative data is unknown. METHODS: This was a cross-sectional study of all patients visiting the outpatient clinic, emergency department, or hospital of the Olmsted Medical Center (OMC), for an appointment or admission during January 1997 or February 1997. Patients were asked to give consent for the use of their medical records for research. Our objective was to gather information on the number and characteristics of patients who refused authorization. RESULTS: Of the 15,997 patients: 90.6% granted authorization; 3.6 refused authorization; 4.5% were undecided; and 1.3% were not asked for authorization. Refusal rates were highest among patients visiting the center for mental health concerns, trauma, or eye care, and among women aged 39 years or older. Undecided rates were highest in women presenting for pregnancy care. CONCLUSIONS: Refusal rates were low for this community practice. However, higher refusal rates in some subgroups, such as older women or patients with mental health concerns, may increase the chance of selection bias in studies involving these patients.

Community impact of childhood varicella infections.

OBJECTIVES: To assess age-specific incidence rates, health care utilization, and lost parental work associated with varicella infection in a population-based cohort of children, and to validate parent-reported health care utilization data. STUDY DESIGN: We conducted a telephone survey of a population-based cohort of 4557 households with children aged birth to 13 years. Medical chart abstraction was used to validate health care utilization information. RESULTS: We report varicella incidence rates in preschool children that are 2 to 2.5 times higher than previous studies. Rates of varicella-related serious complications, hospitalizations, parental work leave, and medication use are comparable with rates reported elsewhere. However, health provider visits occurred only 0.3 to 0.5 times as frequently as estimated in other studies. One hundred percent of reported hospitalizations and serious complications and 92% of provider visits were validated to be within the study time frame through medical chart audits. CONCLUSIONS: Parents are an accurate source of varicella-related health care utilization data. Parent-reported incidence data indicate that varicella infections are increasing in preschool children. This shift to infections in younger children may be related to the increased use of out-of-home care for infants and young children. Furthermore, the shift may after the community burden of varicella because of the observed increased parental work loss and decreased frequency of health care visits in the preschool children.

The relative community burden of otitis media and varicella.

Otitis media is a common and costly condition of childhood, with a great potential for cost savings from an effective vaccine. We present a population-based survey of the family burden of otitis media and compare it with another common childhood illness, varicella, for which vaccine prevention is available and cost-effective. We report yearly rates of affected children, complications, medication use, hospitalizations, parental work absences, and use of special sick-child day care in a population of 4557 households containing 9047 children younger than 13 years of age. Of the 9047 children in the sample, 26.1% were affected by otitis media in the year of the study; 68% of children in the second year of life had at least one episode. About one third of families lost workdays due to otitis media in their children, with an overall average loss of about 3 hours per affected child. Compared with the community burden of varicella, otitis media involves a greater total burden in terms of the number of affected children, the number of episodes, physician visits, prescription drugs, hospitalizations, and surgical procedures. Work loss was 3.4 times greater per family with a varicella case, but the number of families affected by otitis media was 3.3 times greater than for varicella, so that the total amount of family work loss was about the same for both illnesses for the year. The community burden of otitis media should be studied in a population-based longitudinal manner that includes parental work loss as well as health care costs to accurately determine the potential cost-benefit of prevention programs.

Prenatal drug use in Minneapolis-St Paul, Minn. A 4-year trend.

OBJECTIVES: To determine the rates of maternal ingestion of cocaine, marijuana, and opiates in women from Minneapolis-St Paul, Minn, in 1993 and compare them with rates observed in 1989; and to compare outcomes of newborns born to those women with and without evidence of prenatal drug ingestion. STUDY DESIGN: The meconium from newborns of a representative cluster-based sample of women from Minneapolis-St Paul was analyzed for metabolites of cocaine, marijuana, and opiates. The newborns were consecutive births in four urban and suburban hospitals. Maternal demographic information and newborn outcome data were collected and matched to the meconium samples. The race, age, and socioeconomic status of the mothers whose newborns were screened were the same as the demographic characteristics of all women delivering babies in Minneapolis-St Paul in 1990 and 1991. SETTING: Metropolitan hospitals of Minneapolis-St Paul. MAIN RESULTS: Of the 1333 samples, 27 (2.0%) were cocaine positive, 35 (2.6%) were tetrahydrocannabinol positive, and 16 (1.2%) were opiate positive. There were 168 women (22.6%) reporting that they smoked. Detection of tetrahydrocannabinol and cocaine was more common in newborns of women of color, those receiving medical assistance, and those over age 23 years. Newborns with meconium samples positive for cocaine or tetrahydrocannabinol had slightly lower average birth weights but were no more likely to be premature or to require neonatal intensive care unit admission than newborns with no drugs detected in their meconium. Newborns of mothers who smoked throughout pregnancy had lower average birth weights and higher rates of prematurity and neonatal intensive care unit admissions. Standardized rates of cocaine detection in the four hospitals decreased from 4.0% in 1989 to 2.0% in 1993. CONCLUSIONS: Rates of perinatal cocaine detection have declined in the Twin Cities of Minneapolis-St Paul over the past 4 years. In this population, self-reported smoking was associated with more serious adverse outcomes of the newborns than was the detection of cocaine, marijuana, or opiates.

Health care reform in Minnesota. Implications for the rural physician.

Minnesota's health care reform plan (by any name) is a cost-containment bill with provisions to provide health insurance for some uninsured people, to examine quality of care, to increase support for rural provider education and migration to rural practice, and to develop state and regional health planning procedures. It is an ambitious bill with very tight time frames, vague language, and heavy reliance on regional commissions and volunteer groups that are just now being established. Will it have an impact on rural health care? Undoubtedly, it will. But somewhere between what the bill says and the desired outcome is a void that physicians can help fill with constructive work and criticism. If physicians do not take the lead, someone else will fill that void--nonphysician providers, legislators, bureaucrats, or consumers. Or the structure could implode, taking all of us with it.

Substance use in rural Midwestern pregnant women.

OBJECTIVE: To determine the rate of prenatal use of cocaine, cannabis, amphetamines, opiates, and cigarettes in rural midwestern women by analysis of reported use of cigarettes, maternal urine drug screening at admission to labor and delivery, and newborn meconium screening. DESIGN: The cohort of all women presenting to labor and delivery and their newborns were screened by urine and meconium analysis. Demographic information was also collected and matched to the urine and meconium samples. SETTING: Four primary care hospitals in rural Minnesota. Hospitals range in size from 66 to 140 beds, with 400 to 780 deliveries each year. PARTICIPANTS: All women presenting to labor and delivery for evaluation of term or preterm labor between April 4, 1991, and October 4, 1991. MEASUREMENTS/MAIN RESULTS: Overall, drugs not administered during labor were found in a mean (+/- SD) of 3.2% +/- 1.1% of all urine screens. Cannabis was found in 1.2% +/- 0.7% of maternal urine samples, amphetamines in 0.8% +/- 0.58%, opiates in 1.2% +/- 0.7%, and cocaine in 0% +/- 0.3%. Meconium samples were positive in 1.8% +/- 0.9% of cases. Cannabis was found in 1.1% +/- 0.7% of meconium samples, opiates in 0.6% +/- 0.5%, and cocaine in 0.1% +/- 0.1%. No urine samples were positive for more than one drug. One meconium sample tested positive for both cocaine and cannabis. Nearly 4% of patients had either a positive urine specimen or a positive meconium specimen. By history, 24.5% of women admitted to smoking during pregnancy. CONCLUSION: The use of cocaine, cannabis, opiates, and amphetamines was uncommon in this rural population. However, one quarter of the women admitted to smoking during pregnancy, exposing their fetuses to a dangerous substance.

Evaluation in rural practice of a rapid group B streptococcus screening test.

Group B streptococcus (GBS) is the leading cause of infant mortality from infection. A rapid screening immunoassay for GBS was evaluated in a rural obstetrical population and was found to have an unacceptably low specificity (90%) and sensitivity (50%). With a culture proven GBS colonization rate of 6.8%, the positive predictive value of the rapid screening test was only 27%, and the negative predictive value was 96%. Current recommendations for routine vaginal cultures, on all women based on urban research data with high maternal colonization rates (15%-23%) and high prematurity rates (15%-40%) are reviewed in relation to this community's low colonization and prematurity rates.

Preterm birth prevention in a rural practice.

A program for the prevention of preterm births was developed for use in small, nonurban communities. In contrast to other programs, increased emphasis was placed on education and reassessment of "low-risk" women. Potentially preventable preterm births were identified and studied. The potentially preventable preterm birth rate decreased from 3.2% in the 3-year control period to 1.3% during the 2-year study period, a 60% reduction. The preterm neonates who were born during the study period were older, had a greater average birth weight, and had fewer admissions to the neonatal intensive care unit. The percentage of women in preterm labor who presented early enough to receive tocolysis increased from 51% to 98%, and those in preterm labor who delivered at term increased from 56% to 96%. Requiring primarily education and increased awareness, this preterm birth prevention program was successful and inexpensive and may be applicable to similar rural primary care practices.