No abstract

The prevalence and predictors of coronary artery disease were examined in people aged 40 years and younger with insulin-dependent diabetes mellitus. Analysis was performed on those who presented between 1999 and 2003 for kidney and/or pancreas transplant at the University of Minnesota, as all patients who have diabetes mellitus are required to have perioperative cardiology evaluation. The mean age was 33.5 +/- 4.4 years for 88 subjects, all had insulin-dependent diabetes mellitus, and 33% were dialysis dependent. Severe coronary artery disease was found in 18.2% of women and in 24.2% of men. Three-vessel coronary artery disease trended less in women (9.1%) compared with men (12.1%). Multivariate predictors for severe and 3-vessel coronary artery disease included prior coronary artery disease, hypertension duration, and ST-T wave changes on electrocardiogram. Coronary artery disease is twice as high as expected in young woman. Studies on early management for atherosclerosis are warranted in this high-risk population.

Populations at risk for HIV and other sexually transmitted infections (STIs) include those living in rural areas. The authors describe a statewide training program that targeted rural-based health professionals. This program focused on HIV, STIs, and viral hepatitis and was designed to (a) enhance participants' ability to conduct sexual histories and risk assessments, (b) educate clients about risk reduction and prevention, (c) screen for and diagnose these infections, (d) clinically manage clients with positive screening test results, (e) access prevention and other educational materials, and (f) conduct other clinical and public health activities. A total of 122 participants reflecting a wide variety of practice settings attended training at five sites throughout Minnesota; 74% of participants were nurses and 81% characterized employment settings as rural. Nurses and other health professionals in rural settings are an important training priority and can play an important role in education, prevention, screening, and clinical care for HIV and other STIs.