Octreotide Scintigraphy for the Detection of Paragangliomas

Paragangliomas are neuroendocrine tumors located primarily in the head and neck region, but they can also occur at other sites. Confirming the preoperative diagnosis and detecting synchronous tumors may be difficult in some patients. Octreotide is a somatostatin analog that, when coupled to a radioisotope, produces a scintigraphic image of tumors expressing somatostatin type 2 receptors. Paragangliomas, like many neuroendocrine tumors, have been found to have a high density of somatostatin type 2 receptors on the cell surface. This study compared the results of preoperative octreotide scintigraphy with the histopathology in 21 patients who underwent surgery for presumed head and neck paragangliomas. Octreotide scan findings were positive in 16 patients with paragangliomas and negative in 3 patients with other pathology. One false-positive and 1 false-negative result were obtained. Thus, this test had an accuracy of 90%, a sensitivity of 94%, and a specificity of 75%. Previously unidentified synchronous tumors were identified in 5 patients. On the basis of this series of patients, octreotide scintigraphy appears to be a reliable test to detect paragangliomas and may be quite helpful in preoperative planning.

The use of cell salvage during radical retropubic prostatectomy: does it influence cancer recurrence?

OBJECTIVE

To assess whether there is a difference in the biochemical recurrence rate in patients who had radical retropubic prostatectomy (RRP) with or without cell salvage transfusion.

PATIENTS AND METHODS

The records of 769 consecutive patients undergoing RRP between 1992 and 1998 were retrospectively reviewed. Patients having adjuvant hormonal treatment, postoperative external beam radiotherapy, or a follow-up of < 1 year were excluded from the analysis. The remaining 408 patients were categorized into three groups: 87 who received cell-salvaged blood using a commercial cell saver; 264 receiving only autologous transfusion; and 57 with no transfusion. Disease recurrence was defined as a prostate-specific antigen (PSA) level of> 0.2 ng/mL. Bivariate and multivariate logistic regression analyses were used to assess and compare the risk of cancer recurrence in the three groups. Covariates used in the multivariate analyses included Gleason score, preoperative PSA level, seminal vesicle involvement and surgical margins.

RESULTS

The mean (range) follow-up was 40.2 (12-104) months; there were no significant differences among the groups in initial PSA level and Gleason score. In the multivariate logistic regression analysis, the initial PSA, Gleason score, seminal vesicle involvement and surgical margins, but not transfusion group, were independent predictors of recurrence.

CONCLUSION

Cell salvage during RRP does not influence the recurrence of prostate cancer. Cell salvage is a safe method of transfusion during RRP.

Serum citrulline and rejection in small bowel transplantation: a preliminary report

BACKGROUND

There is no known serum marker for intestinal rejection. Serum concentrations of the amino acid citrulline arise almost exclusively from the intestinal mucosa. We examined the impact of acute cellular rejection (ACR) of intestinal allografts on serum citrulline levels.

METHODS

Citrulline concentrations were assayed in serum samples of healthy volunteers (n=6) and seven patients who underwent small bowel transplants (SBTx). Trends in mean citrulline concentrations versus degree of ACR were assessed by matching posttransplantation citrulline concentrations with patients' grade of ACR at time of serum collection. Rejection was confirmed by biopsy and graded by following standardized criteria. An additional patient had citrulline concentrations determined for 31 sequential specimens 3-60 days posttransplant.

RESULTS

Mean citrulline concentrations in controls were significantly higher than posttransplantation samples at any rejection grade. Mean concentrations declined significantly as rejection severity increased. The overall downward trend was statistically significant (P<0.05). In sequential measurements, citrulline levels increased significantly over time with declining severity of rejection. The increase in mean citrulline concentration between posttransplant days 3-16 and 52-60 was significant (P<0.01).

CONCLUSIONS

Serum citrulline levels decline with increasing grade of ACR and may be a useful serum marker for intestinal rejection.

Safety and efficacy of topical mitomycin C in myringotomy patency

OBJECTIVE

To develop an alternative method for prolonged middle ear ventilation using topical mitomycin C.

STUDY DESIGN AND SETTING

Twenty guinea pigs with normal ears had bilateral myringotomies performed using the argon laser. After myringotomy, either mitomycin C (0.4 mg/mL) or saline pledgets were applied topically. Monitoring consisted of otomicroscopy and distortion-product otoacoustic emissions.

RESULTS

Before myringotomy, all tympanic membranes were intact, and distortion-product otoacoustic emissions were measurable. After myringotomy, none (0%) of the saline-treated myringotomies were patent at day 7 as compared with 100% of the mitomycin C-treated myringotomies. At day 42, 10 (52.6%) of 19 mitomycin-treated myringotomies remained patent and 4 (28.6%) of 14 were patent at 131 days. Five (13.1%) ears developed purulent otorrhea; 3 were mitomycin C-treated and 2 were treated with saline solution.- Distortion-product otoacoustic emissions testing did not document any evidence of ototoxicity.

CONCLUSION

Topical mitomycin C appears to be safe and effective at prolonging the duration of myringotomy patency in the guinea pig.

SIGNIFICANCE

Mitomycin C may be useful as an adjunct for preventing myringotomy closure.

Expression of GLUT-1 glucose transporter in borderline and malignant epithelial tumors of the ovary

OBJECTIVE

Cancer cells have increased rates of glucose metabolism when compared to normal cells. One of the mechanisms proposed for the accelerated glucose use in malignant cells is the overexpression of glucose transporters. In this study we evaluated the expression of the GLUT-1 glucose transporter in borderline and malignant epithelial neoplasms of the ovary.

METHODS

Histologic sections of tumor tissues from 21 borderline and 82 malignant epithelial neoplasms of the ovary were stained for GLUT-1 using polyclonal GLUT-1 antibody (Dako, Carpinteria, CA) and the labeled streptavidin biotin procedure. DAB was used as chromagen and tissues were counterstained with hematoxylin.

RESULTS

Normal ovarian surface epithelial cells were either negative or weakly positive. Of the 82 carcinomas, 81 (98.8%) were positive for GLUT-1. The staining intensity was significantly associated with the grade of tumor (P = 0.001). Of the 21 borderline neoplasms, 20 (95.2%) were positive for GLUT-1. Carcinomas had a significantly stronger stain than borderline tumors (P = 0.0001). The intensity of the stain was also stronger in serous carcinomas compared to other subtypes (P = 0. 0001). Positive cells demonstrated a cytoplasmic membrane staining that was more intense in tumor cells farther away from blood supply.

CONCLUSION

Overexpression of the GLUT-1 transporter is associated with the histology and grade of the tumors. Our findings show a progressive increase in the expression of the GLUT-1 transporter from the borderline tumor to the high-grade carcinomas. These data suggest that the expression of this transporter may be closely related to the malignant transformation of epithelial ovarian tumors.

Comparison of two antibiotic regimens in the treatment of perforated appendicitis in pediatric patients

BACKGROUND AND PURPOSE

An increased incidence of post-surgical infectious complications in children admitted with a diagnosis of perforated appendicitis led to development of a disease-specific antibiogram and modification of our post-operative antibiotic regimen.

METHODS

A historical control group comprised of 32 pediatric patients receiving ampicillin, gentamicin, and clindamycin (group AGC) was compared to a cohort of 32 children receiving ticarcillin/clavulanate plus gentamicin (group TG). The surgical procedure, peri-operative management, and inclusion, exclusion and discharge criteria were the same for each group. Outcome measures including length of stay, time to defervesce, incidence of infectious complications, and clinical failures to the antibiotic regimen were compared.

RESULTS

The groups were similar with respect to gender, age, weight, surgical time, pre-operative leukocytes, and number of intra-operative bacterial isolates cultured per patient. Length of stay was 10.1 days in group TG and 12.5 days for group AGC (p = 0.0197). The number of clinical failures was reduced from 9 (28.1%) to 2 (6.3%) in group TG (p = 0.02). The time to defervesce was decreased by 1.4 days, and the number of infectious complications was reduced to 2.5-fold in group TG patients.

CONCLUSIONS

Ticarcillin/clavulanate plus gentamicin was clinically more effective than ampicillin, gentamicin, and clindamycin combination therapy in the management of perforated appendicitis in our pediatric population.

Octreotide scintigraphy for the detection of paragangliomas

Paragangliomas are neuroendocrine tumors located primarily in the head and neck region, but they can also occur at other sites. Confirming the preoperative diagnosis and detecting synchronous tumors may be difficult in some patients. Octreotide is a somatostatin analog that, when coupled to a radioisotope, produces a scintigraphic image of tumors expressing somatostatin type 2 receptors. Paragangliomas, like many neuroendocrine tumors, have been found to have a high density of somatostatin type 2 receptors on the cell surface. This study compared the results of preoperative octreotide scintigraphy with the histopathology in 21 patients who underwent surgery for presumed head and neck paragangliomas. Octreotide scan findings were positive in 16 patients with paragangliomas and negative in 3 patients with other pathology. One false-positive and 1 false-negative result were obtained. Thus, this test had an accuracy of 90%, a sensitivity of 94%, and a specificity of 75%. Previously unidentified synchronous tumors were identified in 5 patients. On the basis of this series of patients, octreotide scintigraphy appears to be a reliable test to detect paragangliomas and may be quite helpful in preoperative planning.

Sociodemographic correlates of visual acuity impairment in Hispanic children and adolescents

Sociodemographic correlates of visual impairment were examined in 6- to 19-year-old Hispanic children and adolescents using data from the Hispanic Health and Nutrition Examination Survey. Mexican American and Puerto Rican children whose parents had 0 to 6 years of education were more likely to remain visually impaired even when tested with their glasses or contact lenses, if any (i.e., with usual correction) than children whose parents reported 12 to 17 years of education. Mexican Americans residing below versus at or above the poverty line were more likely to remain visually impaired even with the usual correction. Mexican Americans enrolled in the Medicaid program or who were without health insurance were more likely to remain visually impaired than Mexican Americans with private health insurance. When tested without glasses or contact lenses, Cuban Americans and Mexican Americans born outside of the mainland United States had lower rates of visual impairment compared to those born in the United States; however, children in this latter group were more likely to remain visually impaired with usual correction than U.S.-born Mexican Americans. These findings suggest that Hispanic children from economically disadvantaged households and those born outside the United States may not be receiving optimal eye care that could improve visual function.

Smoking and joint replacement: resource consumption and short-term outcome

Smoking has been shown to increase morbidity and mortality in surgical procedures. Microvascular and trauma surgeons have documented the adverse effect of smoking in the healing of skin flaps and increased complication rates in the treatment of nonunions. In addition, spine surgeons have shown the adverse effects of smoking in fusion rates. The objective of this study was to assess the effects of smoking on the incidence of short term complications, resource consumption, and length of hospital stay of patients undergoing arthroplasty of the hip and knee. Two hundred two patients who underwent joint replacement surgery were evaluated. A smoking history was assessed for all patients. The number of packs multiplied by the number of years as a smoker were calculated. Operative and anesthesia time and medical severity of illness were documented on all patients. Short term outcome was assessed using hospital charges, length of stay, inhospital consults, and the presence and number of complications during the acute hospitalization. One hundred forty-one primary and 61 revision procedures were done. The mean age of the patients was 66.07 years. Sixty-one percent of the patients had osteoarthritis, 3.9% had rheumatoid arthritis, 4.9% had osteonecrosis, 28% had a failed total knee or hip arthroplasty and 2% had a periprosthetic fracture. There were 25 patients who smoked and 177 patients who did not smoke. For patients who currently smoke, the mean number of packs of cigarettes smoked per day multiplied by the number of years as a smoker was 28.3. The average length of stay in the hospital was 5.1 days and the average hospital charges were $31,315. Patients who smoked were younger and had fewer comorbidities than patients who did not smoke. However, patients who smoked were found to have statistically longer surgical time and higher charges adjusted for age, procedure, and surgeon than patients who did not smoke. Patients who smoked also had longer anesthesia times. A history of smoking is obtained easily on all patients. Preoperative screening for nicotine use can predict operative time and health resource consumption. The exact reasons why patients who smoked had higher hospital charges remain elusive. Probable reasons include higher degree of operative complexity (orthopaedic severity of illness). In addition patients who smoked previously also had better short term outcome than patients who currently smoke. This indicates the importance of smoking abstinence before joint replacement surgery and other surgical procedures. Regardless of the exact causes, it is more expensive to treat patients who smoke. Contracting for orthopaedic care should include a history of smoking.

Proportional assist ventilation in low birth weight infants with acute respiratory disease: A comparison to assist/control and conventional mechanical ventilation

OBJECTIVES

To compare the physiologic efficacy and safety aspects of proportional assist (PA), assist/control (A/C), and intermittent mandatory ventilation (IMV) in very low birth weight infants with acute respiratory illness and to test the hypothesis that ventilatory pressure requirements are lower and arterial oxygenation is improved during PA when compared with IMV or A/C at an equivalent inspired oxygen fraction.

STUDY DESIGN

Randomized, 3-period, crossover design.

METHODS

Thirty-six infants were stratified by birth weight (600 to 750, 751 to 900, and 901 to 1200 g) and exposed to consecutive 45-minute epochs of the 3 modalities in a sequence chosen at random. Tidal volumes of 4 to 6 mL/kg were targeted during A/C and IMV. The IMV rate was matched to the rate during an A/C test period. PA was adjusted to unload the resistance of the endotracheal tube and the disease-related increase in lung elastic recoil.

RESULTS

Compared with A/C and IMV, PA maintained similar arterial oxygenation with lower airway and transpulmonary pressures (15% to 44% reduction depending on the index variable). The oxygenation index decreased by 28% during PA. No adverse events were observed. The number and severity of apneic episodes and periods of arterial oxygen desaturations were similar with the 3 modes. Similar results were obtained within each birth weight subgroup.

CONCLUSIONS

PA safely maintains gas exchange with smaller transpulmonary pressure changes compared with A/C and IMV. It may therefore offer a way of reducing the incidence of chronic lung disease in low birth weight infants.

Speech recognition after implantation of the ossified cochlea

OBJECTIVE

Insertion of complex, multichannel cochlear implant (CI) electrode arrays into ossified cochleas is now performed routinely. This study describes the hearing results obtained in a consecutive series of 21 patients with obstructed cochleas and compares these results to those in patients with open cochleas. The purpose of this study was to determine whether patients with ossification have speech perception results that are inferior to those of patients with no evidence of cochlear bone formation.

STUDY DESIGN

Retrospective analysis of consecutive clinical series.

METHODS

CI database review of 191 CI procedures at the University of Miami Ear Institute between 1990 and 1997 showed that 24 (13%) procedures were performed on patients with ossified cochleas. Open-set speech recognition scores obtained on the 11 pediatric and 7 adult English-speaking patients are compared to scores of 51 adult and 61 pediatric English-speaking CI patients with open scala.

RESULTS

Results of open-set speech recognition measures in adults and children with ossified cochleas were not significantly different from those of the reference groups.

CONCLUSION

Speech recognition results of patients with ossified cochleas are essentially equal to those of patients with open cochleas. Degree of obstruction appears to have less effect on outcome than other factors such as duration of profound deafness or communication methodology in children among this group.

Prenatal care in cocaine-exposed pregnancies

OBJECTIVE

To examine the effect of prenatal care with and without drug rehabilitation on perinatal outcome in cocaine-using women.

METHODS

Cocaine-exposed pregnancies of 905 human immunodeficiency virus (HIV)-negative women were frequency matched (ratio 6:1) and compared with 150 nonusers. Cocaine subgroups consisted of 278 women who received prenatal care and drug rehabilitation ("comprehensive care"), 206 women who received prenatal care only, and 421 who received neither. Maternal and fetal complications, drug screening, and attendance were recorded. Pregnancy rates and HIV seroconversion were determined over the year following delivery.

RESULTS

The groups were similar in age, race, education and poverty level. Linear trends of increasing incidence of maternal complications were seen across the four groups. Comparing nonusers with cocaine users, the odds ratios, with 95% confidence intervals were: 28.0 (4.2, 103.2) for both anemia and weight under 100 lb; 2.4 (1.8, 5.0) for urinary tract infections; 15 (4.6, 36.1) for syphilis; and 11.2 (4.0, 35.8) for other sexually transmitted diseases. Perinatal outcome measures were similar for nonusers and "comprehensive care" groups but significantly worse for the other two groups. Four maternal deaths and two myocardial infarctions occurred with no care. Positive toxicology at delivery was 1.5 and 4.3 times more likely for the two groups without drug treatment, than for "comprehensive care." Congenital anomalies and HIV seroconversion increased in cocaine users. Repeat pregnancy was less likely and more often drug free with "comprehensive care."

CONCLUSION

"Comprehensive care" of the cocaine-using gravida increases the likelihood of carrying to term, having fewer complications, being drug free at delivery, and having fewer exposed repeat pregnancies.

Prevalence of uncorrected binocular distance visual acuity in Hispanic and non-Hispanic adults. Results from the HHANES and the NHANES I

OBJECTIVE

This study aimed to provide a comparative analysis of American population-based prevalence of uncorrected binocular distance visual acuity in Hispanics and non-Hispanics.

DESIGN

The study design was a population-based survey.

PARTICIPANTS

Data from the Hispanic Health and Nutrition Examination Survey between 1982 and 1984 and the National Health and Nutrition Examination Survey I from 1974 through 1975 were analyzed to investigate the epidemiology of uncorrected binocular distance visual acuity in adults 25 to 74 years of age in Cuban Americans (N = 391), Mexican Americans (N = 1350), Puerto Ricans (N = 504), African Americans (N = 245), and non-Hispanic white Americans (N = 2571).

MAIN OUTCOME MEASURE

Uncorrected binocular distance visual acuity in both eyes was assessed using Sloan letters or Landolt rings.

RESULTS

Prevalence rates of 20/50 or worse uncorrected binocular distance visual acuity were 22%, 24%, 19%, 18%, and 32% for African Americans, Cuban Americans, Mexican Americans, Puerto Ricans, and non-Hispanic whites, respectively. After adjustment for gender and age, the rates were significantly higher (P < 0.05) for non-Hispanic whites compared to each of the other ethnic groups. Significant increases in the prevalence of 20/50 or worse distance visual acuity were observed for increasing age groups (25-39, 40-59, and 60-74 years) within each gender-ethnic subgroup. Analysis of differences in prevalence by gender (controlling for age) indicated a slightly higher prevalence of 20/50 or worse distance visual acuity in women than in men (range of odds ratios, 1.1-2.1). Based on 1993 census population estimates in the United States, more than 42 million adults 25 to 74 years of age have an uncorrected binocular distance visual acuity of 20/50 or worse. Approximately 1.7 million of these adults are of Hispanic origin.

CONCLUSION

The prevalence of impaired uncorrected binocular distance visual acuity generally is lower in Hispanics than in non-Hispanic whites.

Relation of fasting insulin to blood pressure and lipids in adolescents and parents

This study was intended to clarify the relation between fasting insulin, lipids, and blood pressure in adolescents before the onset of hypertension and to examine the association of these data with similar data obtained in their parents. The participants in this study were 183 adolescents 14 to 18 years old (96 girls) completing a 4-year intervention trial and their parents (164 mothers, 122 fathers). Blood pressure was measured twice on the right arm in a seated position using a random-zero sphygmomanometer. Fasting blood samples were obtained for lipid and insulin analyses. Fasting insulin was significantly correlated with systolic blood pressure in the adolescents and also in the parents before and after adjustment for body mass index. Fasting insulin was correlated significantly with levels of cholesterol, triglycerides, and HDL and LDL cholesterol in the adolescents. It was correlated only with triglycerides and HDL-cholesterol in mothers and fathers. After adjustment for body mass index, the correlations between fasting insulin and lipids in the children were not significant. A significant relation was shown between children's systolic blood pressure and mothers' fasting insulin and systolic blood pressure. Significant correlations were found between the children's and fathers' triglycerides and HDL-cholesterol, whereas significant correlations were found for fasting insulin and all lipids between mothers and children, and these remained significant after adjustment for body mass index. These results show (1) a significant relation between fasting insulin and both lipids and systolic blood pressure in adolescents and (2) a significant relation for these factors between adolescents and their parents. Although weight appears to play an important role in this relation during adolescence, genetic and environmental factors other than those mediated via weight may control insulin metabolism within families. The data support a role for studies during early biological development to address these issues.

Major depressive disorder, depressive symptoms, and bilateral hearing loss in hispanic adults

Studies in non-Hispanic whites have documented higher rates of hearing loss in adults with depression versus those without depression. Data from the Hispanic Health and Nutrition Examination Survey were used to investigate associations between depression and bilateral hearing loss in Cuban-American, Mexican-American, and Puerto Rican adults 20-74 years of age. Pure tone thresholds were calculated by averaging thresholds obtained at 500, 1000, and 2000 Hz separately for each ear. Hearing loss was defined as bilateral pure tone average threshold levels greater than 25 db. Lifetime history of a major depressive episode was assessed by the Diagnostic Interview Schedule, and depressive symptoms were assessed by the Center for Epidemiologic Studies Depression Schedule. Prevalence of overall hearing loss was consistently lower in Hispanics with a history of major depressive disorder than among those without such a history. Odds of hearing impairment was significantly greater among Puerto-Ricans reporting more depressive symptoms versus fewer symptoms. However, no such associations were found among Mexican-Americans or Cuban-Americans. In conclusion, despite the findings in Puerto Ricans with depressive symptoms short of major depression, hearing impaired Hispanics overall do not appear at increased risk of major depressive disorder.

Sociodemographic and educational correlates of hearing loss in Hispanic children

Sociodemographic and educational correlates of hearing loss were examined in Cuban-American, Mexican-American and Puerto Rican children 6-19 years of age. Logistic regression analyses indicated a greater risk of bilateral hearing loss among children living in crowded housing conditions or without health insurance, as well as among those who were below expected school grade level and whose parents reported low educational attainment levels. However, the strengths of these associations were small to moderate in magnitude and were not always consistent across the ethnic subgroups. These findings provide some evidence that hearing-impaired Hispanic children are more likely to reside in economically disadvantaged families and to be below their expected school grade level.

Prevalence of childhood hearing loss. The Hispanic Health and Nutrition Examination Survey and the National Health and Nutrition Examination Survey II

Comparative analysis of the epidemiology of childhood hearing loss was undertaken among African-American, Hispanic-American, and non-Hispanic white children. Audiometric data on children aged 6-19 years were obtained from 688 African Americans, 330 Cuban Americans, 2,602 Mexican Americans, 1,025 Puerto Ricans, and 3,243 non-Hispanic whites who participated in either the National Health and Nutrition Examination Survey II, 1976-1980, or the Hispanic Health and Nutrition Examination Survey, 1982-1984. Hearing loss was defined as a pure-tone decibel hearing threshold level (averaged over 500, 1,000, and 2,000 Hz) greater than 15 in the ear with the best response. The prevalence (per 1,000) of bilateral hearing loss was 17.0 for African-American, 68.3 for Cuban-American, 27.6 for Mexican-American, 57.7 for Puerto Rican, and 15.5 for non-Hispanic white children. Differences in prevalence by ethnicity/race diminished when a more stringent definition of hearing loss (i.e., moderate or greater than 30 dB hearing threshold level) was used. There were no adolescent African-American males aged 16-19 years who had a hearing loss. After adjustment for age, the odds of hearing loss was significantly greater in males than in females only in non-Hispanic whites (odds ratio = 2.2; 95% confidence interval 1.6-3.3). On the basis of 1993 census population estimates in the United States, over 819,000 children aged 6-19 years have some degree of hearing impairment, and over 216,000 of these children have moderate or greater hearing impairment.

Type A behavior pattern and change in blood pressure from childhood to adolescence. The Minneapolis Children's Blood Pressure Study

The association of the Type A behavior pattern with change in blood pressure was examined in a multiethnic sample of schoolchildren. Blood pressure was assessed in 1978 (mean age = 8 years) and approximately biannually thereafter through 1987-1990, when a post-high school screening was completed. The Matthews Youth Test for Health (MYTH) was completed by the teachers of a sample of participants in 1982 (n = 502). The Jenkins Activity Survey (JAS) was completed by all adolescents who participated in the post-high school screening (n = 816). Males were more likely to be classified as Type A than were females by the JAS and the MYTH. Type A status was not associated cross-sectionally with elevated blood pressure. JAS-assessed Type B males had significantly higher mean post-high school fourth- and fifth-phase diastolic blood pressures than did Type A males (70.2 mmHg vs. 68.2 mmHg, p < 0.05; 68.1 mmHg vs. 65.2 mmHg, p < 0.01). JAS-assessed Type A/B status was not associated with 10-year change in blood pressure. MYTH-determined Type B females tended to have higher diastolic blood pressures than MYTH-determined Type A females throughout the 10-year study period. Results from this study did not confirm the hypothesis that Type A participants would have significantly higher blood pressures than Type B participants at the time of Type A assessment; nor did they confirm the hypothesis that Type A participants would exhibit greater increases in blood pressure than Type B participants over a 10-year period.

Comparison of serum calcium levels between junior high school children with high-normal and low-normal blood pressure. The child and adolescent blood pressure program

The objective of this study was to compare serum calcium levels, dietary calcium intake, and urinary calcium excretion between junior high students with high-normal and low-normal blood pressure. The study was conducted in 11- to 14-year-old children recruited after blood pressure screening of 5th to 8th grade Minneapolis and St. Paul Public School students. Comparisons were made between a group of 243 children selected from the upper 15 percentiles of the blood pressure distribution (high-normal group) and 40 children randomly selected from the lowest 10% of the blood pressure distribution (low-normal group). Blood samples were obtained from the participants at clinic visits conducted after school. Calcium measurements were based on the principle that serum calcium is found in three forms: 1) an ionized fraction; 2) a fraction complexed with organic anions such as citrate, phosphate, and lactate; and 3) a protein-bound fraction. Dietary calcium intake was determined from food diaries, and urinary electrolytes were determined in 24-h urine collections. Serum total calcium levels were not significantly different between groups. However, serum ultrafilterable, true ionized, ionized normalized for pH, and complexed calcium levels were significantly greater in the low-normal group. There was no significant difference in 24-h intake of calcium or other nutrients between the groups. The low-normal group excreted significantly more calcium than the high-normal group, but there were no significant differences in sodium, potassium, or chloride excretion. This report of the relation between calcium and blood pressure represents the first study in children or adolescents to include serum, dietary, and urine data.(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of low sodium diet or potassium supplementation on adolescent blood pressure

The roots of essential hypertension extend back into the first two decades of life, suggesting that effective intervention during those years may lead to a reduction in the incidence of adult hypertension. Decreasing the dietary sodium/potassium ratio offers a potentially effective approach to blood pressure reduction. This study tested the feasibility of 3-year sodium reduction or potassium supplementation in adolescents and the effect of these interventions on the rate of rise of blood pressure during adolescence. After 19,452 5th to 8th grade students were screened, 210 from the upper 15 percentiles of blood pressure distribution (105 boys, 105 girls) were randomly assigned to one of three groups: low sodium diet (70 mmol sodium intake per day), potassium chloride supplementation (normal diet plus 1 mmol/kg potassium chloride per day), or placebo (normal diet plus placebo capsule). Capsules for the potassium chloride and placebo groups were administered in a double blind protocol. Blood pressure was measured every 3 months for 3 years. The effect of the intervention was determined by comparing the rate of rise (slope) of blood pressure among the groups using a random-coefficient growth curve model. The boys groups and the girls placebo group had similar positive blood pressure slopes that were significantly different from zero. The girls low sodium group had a slightly negative slope (significantly lower than the slope of the girls placebo group), and the girls potassium group had a slightly positive slope. Both of these slopes were not significantly different from zero and were significantly lower than the slopes of the respective boys groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Change in survival from out-of-hospital cardiac arrest and its effect on coronary heart disease mortality, Minneapolis-St. Paul. The Minnesota Heart Survey

Emergency medical services with advanced life support systems were implemented in the Minneapolis-St. Paul, Minnesota, area in the mid-1970s. To assess the impact of emergency medical services on coronary heart disease mortality, the authors reviewed ambulance records and hospital emergency room logs for possible out-of-hospital cardiac arrest cases in the period 1972-1982. Potential cases, and their survival to discharge, were validated by hospital record review and were checked against Minnesota death certificates for the year of cardiac arrest and the year following cardiac arrest. Age-adjusted rates of survival to 1 year after cardiac arrest (per 100,000 population) for survivors of out-of-hospital cardiac arrest aged 30-74 years increased significantly from 1972 to 1982 for men (1.8 vs. 11.7; p less than 0.00001) and for women (0.5 vs. 3.5; p less than 0.01). Coronary heart disease mortality rates declined in that period by 34.9% for men (from 527.5 per 100,000 to 343.3 per 100,000) and by 41.7% for women (from 168.6 per 100,000 to 98.3 per 100,000). The authors estimate that improved survival from out-of-hospital cardiac arrest contributed 5.4% (9.9 of 184.2) of the mortality decline for men and 4.3% (3.0 of 70.3) of the decline for women. This was a significant contribution to the decline in coronary heart disease mortality, but it explains only a small part of it.

The effect of dentin pre-treatment and heat-augmented cure on marginal gap formation of a dentin bonding agent

This study evaluated the effect of enhancing the cure of a DBA and the effect of dentin surface pre-treatment on marginal gap formation. Dentin cavities were prepared on extracted teeth and were pre-treated either with EDTA or phosphoric acid. Marginal leakage was expressed as percent length of margins with gaps. The mean percent length of margins with gaps for the chemically cured groups ranged from a maximum of 97% to a minimum of 85%. For the chemical/thermal-cured group, the mean percent length of margins with gaps was 95%, 95%, 73%, 35%, and 65%, corresponding to the following: pretreatment, no pre-treatment, EDTA, and phosphoric acid for 60, 15, or five s, respectively. SEM micrographs showed partial removal of one smear layer with EDTA and total removal of the smear layers with phosphoric acid. It is concluded that dentin pre-treatment methods have an effect on the percent length of margins with gaps when the DBA used had its cure supplemented with heat.

Renal preservation after warm ischemia using oxygen free radical scavengers to prevent reperfusion injury

Oxygen free radicals damage kidneys and accumulate during the period of preservation prior to transplantation. We hypothesized that a perfusate containing either an oxygen free radical scavenger such as ceruloplasmin, or an iron-chelating agent such as deferoxamine, would improve kidney preservation. Thirty-eight mongrel dogs underwent autotransplantation of the left kidney after 30 min of warm ischemia and 48 hr of machine perfusion (MOX-100, Water Instruments, Rochester, MN) at 5 degrees C and pH of 7.4. The right kidney was removed at the time of autotransplantation. Four blind code-labeled preservation solutions were tested. SGF-I was used for the control group (Group 1, n = 13), and the remaining animals were transplanted with kidneys preserved with one of three solutions modified from the basic SGF-I solution: Group 2, SGF-I plus deferoxamine (656 mg/liter), n = 8; Group 3, SGF-I ceruloplasmin enriched (72 mg/dl), n = 8; and Group 4, SGF-I ceruloplasmin reduced (3.4 mg/dl), n = 9. Serum creatinine levels were measured daily for 2 weeks and survival curves for each of the four groups were estimated by the Kaplan-Meier method. Peak mean serum creatinine levels +/- standard errors in Groups 1 through 4 were 12.6 +/- 1.97, 7.8 +/- 0.90, 7.1 +/- 1.26, and 8.2 +/- 1.09, respectively. Repeated measures analysis of variance showed statistically significant differences between the groups with respect to their serum creatinine profiles (Wald's test x2 with 3 df = 22.39, P value less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Elevated blood pressure among Southeast Asian refugee children in Minnesota

The blood pressures and body sizes of children aged 10-15 years in the Minneapolis and St. Paul, Minnesota, public schools were measured during 1986 and 1987. The sample consisted of 1,680 Southeast Asian refugees--including 219 Cambodians, 1,086 Hmong, 149 Lao, and 226 Vietnamese--and 3,424 blacks and 11,336 whites. Mean systolic blood pressure in Hmong boys was higher than that in black boys and white boys. Mean systolic blood pressures of Hmong, Lao, and Vietnamese girls were lower than those of black girls and white girls. The mean diastolic blood pressures of Hmong boys and of Cambodian and Hmong girls were greater than those of blacks and whites of the same sexes. Southeast Asian children were shorter and weighed less than black children and white children. Body size may confound associations between ethnic groups and blood pressures and may obscure the problem of hypertension among the smaller Southeast Asian children. Southeast Asian boys had greater mean systolic blood pressures than did black and white boys across all weight strata; a similar contrast among girls did not reveal this difference. The risk of hypertension, defined by US National Heart, Lung, and Blood Institute guidelines, was assessed in multiple logistic regression analyses that controlled for differences in weight, height, age, and pulse rate. The odds ratios for hypertension, relative to blacks and whites of the same sexes, were 2.69 (95% confidence interval (CI) 1.85-3.65) in Hmong boys, 2.89 (95% CI 1.35-6.21) in Lao boys, 2.10 (95% CI 1.03-4.28) in Cambodian girls, and 1.49 (95% CI 1.00-2.20) in Hmong girls. Hypertension and subsequent cardiovascular disease may emerge as a significant problem among Southeast Asian refugees in the United States.

Resin-bonded fixed partial dentures: a recall study

A clinical recall program was initiated at the University of Minnesota to evaluate the longevity and factors affecting longevity of resin-bonded fixed partial dentures (FPDs). Of the 49 resin-bonded FPDs evaluated in the clinic, 43 were acid-etched metal, resin-bonded FPDs, four were combinations of resin-bonded and conventional FPDs, and two were composite resin pontics. None of the combination FPDs and one of the two composite resin pontics were judged as failed at the examination. Of the 43 acid-etched metal resin-bonded FPDs, 15 were found to be debonded (failure rate = 34.9%). The average length of service for the 43 FPDs was 47.3 months. The average time of placement to debondment was 33 months for the 15 debonded FPDs. The failure rate for maxillary FPDs and FPDs with two retainers were significantly lower than the failure rate for mandibular FPDs and FPDs with more than two retainers (p greater than 0.05). The clinical significance of the present study was discussed.

Diastolic fourth and fifth phase blood pressure in 10-15-year-old children. The Children and Adolescent Blood Pressure Program

Measurement of diastolic blood pressure is complicated by the presence of two diastolic Korotkoff phases (fourth phase and fifth phase) in many children and adults. In the present study, diastolic fourth phase and diastolic fifth phase were evaluated in 1986-1987 in 19,274 Minneapolis-St. Paul school children aged 10-15 years. Approximately 50 percent of the children had no difference between fourth phase and fifth phase (i.e., fourth phase - fifth phase = 0) and 15 percent had a difference of only 1-4 mmHg. However, the fourth phase - fifth phase difference was 5-10 mmHg in 20 percent, 11-20 mmHg in 11 percent and greater than 21 mmHg in 3 percent of the children. Statistical analyses showed that the fourth phase - fifth phase difference tended to be greater in boys than girls and in older than younger children, was positively related to height, systolic blood pressure and fourth phase blood pressure, and negatively related to body mass index and fifth phase blood pressure. Using fifth phase instead of fourth phase in 10-12-year-old children and fourth phase instead of fifth phase in 13-15-year-old children to define diastolic blood pressures significantly changed the prevalence for significant diastolic hypertension by 2-3 percent.

Ratio of cuff width/arm circumference as a determinant of arterial blood pressure measurements in adults

Recommendations state that the optimum ratio of blood pressure cuff width/arm circumference (CW/AC) is about 0.4. In this study of middle-aged men (n = 940) and women (n = 1484), we analysed the effect of CW/AC on blood pressure measurement variability and its interaction with age, body mass index (BMI), pulse rate and room temperature. In univariate polynomial regression, the variability (R2) in blood pressure that was explained by CW/AC was greater for women (systolic 6.3% and diastolic 5.7%) than for men (2.0% and 0.5%). In multivariate analysis the maximum variability explained independently by CW/AC was 2.7% for male and 6.7% for female systolic blood pressure, and 1.1% and 6.0% for male and female diastolic blood pressure, respectively. For systolic blood pressure this represented 10.4% of the explained variability in men and 9.3% of that in women. CW/AC is an important independent contributor to inter-individual variation in blood pressure measurement. It should therefore be taken into consideration in epidemiological studies and when medical care is being planned.

Prevalence of "significant" hypertension in junior high school-aged children: the Children and Adolescent Blood Pressure Program

Blood pressure (BP) data obtained during a BP screening program were analyzed to determine the prevalence of "significant" hypertension, defined by the Second National Heart, Lung, and Blood Institute Task Force on Blood Pressure Control in Children-1987 as the level of BP above which medical evaluation and intervention are recommended. In 14,686 black and white St. Paul and Minneapolis schoolchildren aged 10 to 15 years, BP was measured twice during an initial screening examination. Children with systolic BP in the upper 30 percentiles of distribution after the initial screening had their BP remeasured two additional times at a rescreening examination. The prevalence of significant hypertension was determined according to BP criteria established by the Task Force report. After the two screening BP measurements were averaged, significant systolic hypertension was found in 1.0%, significant diastolic hypertension in 3.5%, and significant systolic or diastolic hypertension, or both, in 4.2% of the students. After the rescreening examination, the percentage of students remaining with significant hypertension was reduced to 0.3% for systolic, 0.8% for diastolic, and 1.1% for systolic or diastolic hypertension, or both. These results show that significant hypertension is uncommon in pre-high-school students and confirm the need for repeated BP measurements to make an accurate diagnosis of hypertension. However, the results should not detract from current recommendations to monitor BP in children on a yearly basis to detect longitudinal BP tracking patterns that may be consistent with early essential hypertension.

Canines erupted through grafted alveolar cleft defects in patients with alveolar clefts: a pulp testing evaluation study

An electric pulp tester (EPT) was used to evaluate the pulpal response of erupted canines in 75 patients: 16 patients with unilateral cleft palate who received autogenous bone grafts to correct their alveolar cleft defects before canine eruption; 35 patients without cleft palate whose canines erupted spontaneously, but who required orthodontic treatment for alignment; and 24 patients without clefts whose canines required surgical uncovering and orthodontic assistance for eruption. Thirty-one percent of the erupted canines in the patients with grafted unilateral clefts did not respond to EPT, whereas all canines in the contralateral noncleft side responded to EPT. There was no clinical or radiographic evidence of pulpal pathosis of the canines that had erupted through the grafted alveolar clefts. However, these teeth had a high incidence of nonresponsiveness to pulp stimulation, therefore necessitating close follow-up in case they show eventual signs of pulpal degeneration that may require endodontic intervention.

Postural changes in blood pressure and pulse rate among black adolescents and white adolescents: the Minneapolis Children's Blood Pressure Study

Because studies have suggested a possible relation between vascular responsiveness to postural changes and risk of subsequent myocardial infarction, the reactivity of blood pressure and pulse rate to change from supine to standing positions was examined in 158 black males, 144 black females, 342 white males, and 272 white females aged 14-16 years. The study was part of the Minneapolis Children's Blood Pressure Study and was conducted during October to December 1985. Two blood pressure readings and one pulse reading were taken after five minutes of supine rest, immediately upon standing, and five minutes after standing. After adjustment for body mass index, mean systolic blood pressure decreased, and fourth- and fifth-phase diastolic blood pressures and pulse rate increased from supine to standing positions in all race and sex groups. Black males had significantly larger changes in systolic pressure than did white males (-5.9 vs. -4.1 mmHg), and males had significantly larger changes in fourth- and fifth-phase diastolic pressures compared with females of the same race (fourth-phase diastolic pressure, 8.0 vs. 4.1 mmHg for blacks and 10.0 vs. 4.8 mmHg for whites). Fifth-phase diastolic pressure increased more than did fourth-phase diastolic pressure in all groups. No race or sex differences were seen for pulse changes. For all race-sex groups, decreases in systolic pressure were positively correlated with initial levels of supine systolic pressure, whereas increases in fourth- and fifth-phase diastolic pressures were negatively correlated with corresponding initial levels. Measurement of postural changes may provide a clinically simple and reproducible way of testing for abnormalities in blood pressure and may better discriminate those at high risk of hypertension and its cardiovascular complications than would the commonly used single-seated blood pressure measurement.

Persistent elevation of blood pressure among children with a family history of hypertension: the Minneapolis Children's Blood Pressure Study

We examined the blood pressure of children with and without a family history of hypertension in a longitudinal study. Supine blood pressures were first measured in schoolchildren (mean age 8 years) in 1978 and then on nine more occasions until 1986. Blood pressures of parents were measured in the seated position and their medical histories were obtained in home interviews carried out between 1978 and 1979. Children with a family history of hypertension had a higher mean systolic blood pressure (SBP) at the first screening compared to children without such a family history. This difference persisted at each of the succeeding nine school visits. The parents in hypertensive families had a lower income, greater body weight, were less well-educated and were more likely to be black than parents in families without a history of hypertension. Mothers in hypertensive families were more likely to have a history of heart disease and elevated blood pressure during pregnancy than mothers in normotensive families. The correlations between blood pressure of mothers and their children tended to be higher than those between fathers and their children. Elevated blood pressure emerges well before adolescence among children with a family history of hypertension and the family environment appears to play an important role in its development.

"Significant" diastolic hypertension in pre-high school black and white children. The children and adolescent blood pressure program

The Second Task Force on Blood Pressure Control in Children defines "significant" hypertension as blood pressure persistently above the 95th percentile for age-sex specific distribution. In this report we present preliminary data on the prevalence of significant diastolic hypertension in pre-high school black and white children after repeated blood pressure measurements. Blood pressure was measured in 10,446 children two times at an initial screening in school and remeasured two times at a rescreening in 2,808 children from the upper 30 percentiles of the initial screening distribution. Significant hypertension was found in 653 children (6.3%) after the first screening measurement and in 475 children (4.5%) after averaging the first two screening measurements. At the rescreening, the prevalence of significant hypertension was further reduced in this cohort to 1% after one measurement and to 0.8% after averaging the two measurements. The prevalence of significant systolic hypertension had fallen to 0.47% after averaging the two rescreening measurements. These data suggest that the prevalence of significant hypertension is very low in pre-high school children.

Discrepancies in racial designations of school children in Minneapolis

To determine the frequency of inaccuracies in racial designations of school children in a health survey, racial designations were examined for a sample of 1,509 children in Minneapolis public schools who participated in the first home interview of the Minneapolis Children's Blood Pressure Study. The data were obtained from three sources: the school enrollment data based on parentally supplied information and teachers' visual judgments, school survey interviewers participating in a research project, and the parents themselves, at home interviews. Assuming the correctness of the information obtained from the parent in the home interview, cross tabulation comparisons were made of the accuracy of the information obtained from the other sources, and within sources. Results show a high degree of agreement between the parents' or teachers' designations at enrollment, and survey interviewers' sight judgments. Furthermore, sight judgments of interviewers show high repeatability. There was a significant degree of disagreement between the designations by teachers' and screeners' visual judgments, obtained in school, and the interviews with the parents. Misidentification occurred for up to 20 percent of Native American children, a rate which, if prevalent, may significantly affect public health studies which are based on racial identifications of school children. When possible, researchers studying Native American or mixed race populations should verify racial designations from school documents or sight judgments. Questionnaires to be answered by parents need to have sufficiently detailed categories to enable parents of different racial groups to identify different racial groups accurately.

Trends in cardiovascular risk factors in an urban black population, 1973-74 to 1985: the Minnesota Heart Survey

Cardiovascular disease mortality rates have fallen dramatically in blacks in the United States. To determine whether this may be due to a decline in cardiovascular risk factors, we compared risk factors in a 1985 urban black population, ages 35 to 69, with those obtained in blacks of the same area in 1973-74. Age-adjusted mean body mass and the prevalence of overweight increased significantly over the 12-year period in both men and women. Mean systolic blood pressures declined significantly in both sexes, diastolic blood pressure declined significantly in men, and the proportion of men and women hypertensives on medication and under control increased. The overall prevalence of cigarette smoking changed very little, but the proportion of heavy smokers decreased significantly in men. No significant changes occurred in resting heart rate. Concurrently with these risk factor trends, age-adjusted heart disease mortality rates in area blacks fell 27% between 1968-73 and 1979-84, and stroke mortality fell 58%. Changing risk factors may be contributing to declining cardiovascular mortality rates in blacks. However, overweight seems to be a worsening problem.

Out-of-hospital coronary death in an urban population--validation of death certificate diagnosis. The Minnesota Heart Survey

To assess the validity of death certificate diagnoses of out-of-hospital coronary heart disease deaths, the authors studied a one-third random sample of out-of-hospital deaths occurring in 1979 in Minneapolis-St. Paul, Minnesota, residents. Death certificates with diagnoses possibly containing coronary heart disease deaths were enumerated, and cause of death was recorded from the certificate in two ways: as the first listed ("immediate") cause and as the "underlying cause" assigned by a trained nosologist. Validation was performed by standardized physician review of information obtained about the death, which included one or more of the following: an interview with a relative or friend, physician report, autopsy report, medical record, and/or nursing home record. Missing information was frequent, but cases with at least an informant interview and/or autopsy report (82%) were representative and could be used for validation. The sensitivity and specificity of the underlying cause of coronary heart disease (International Classification of Diseases, Ninth Revision, codes 410-414, 427) on the death certificate were 90.3% and 82.7%, respectively, compared with the physician-assigned diagnosis. For the immediate cause, sensitivity and specificity were 90.3% and 67.9%, respectively. These findings suggest that the validity of death certificates for out-of-hospital coronary heart disease death is high, as assessed by this method of retrospective physician review.

Improvement in long-term survival among patients hospitalized with acute myocardial infarction, 1970 to 1980. The Minnesota Heart Survey

The mortality rate associated with coronary heart disease in the United States has declined steadily since 1968, but the reasons for this favorable trend have not been completely elucidated. In particular, it is not clear to what extent the decline reflects decreasing incidence as opposed to improved survival. To assess whether improved survival after myocardial infarction has contributed to the decline, the Minnesota Heart Survey compared the four-year survival rate in patients discharged with a diagnosis of acute myocardial infarction from hospitals in the Twin Cities area in 1970 and 1980. After adjustment for clinical characteristics related to outcome, the survival rate among patients with a definite myocardial infarction was significantly higher in the 1980 than in the 1970 group. The four-year survival for men was 35 percent better in the 1980 than in the 1970 group (95 percent confidence interval, 21 to 50 percent), and for women it was 27 percent better (95 percent confidence interval, 1 to 46 percent). Improvement in survival during the period of hospitalization accounted for 70 percent of the overall gain in survival between 1970 and 1980 in men and for virtually all of the gain in women. We conclude that improved long-term survival among patients with acute myocardial infarction has made an important contribution to the decline in mortality from coronary disease.

A comparative study of the effects of dentinal bonding agents and application techniques on marginal gaps in Class V cavities

The effectiveness of eight dentinal bonding agents (DBA's) and four of their combinations in eliminating marginal gaps in class V cavities was evaluated by the bulk method of composite application and two different incrementation techniques. The cavities were prepared one-half in enamel and one-half in dentin. Basic fuchsin 0.5% in propylene glycol was used for detection of the presence of gaps. For each cavity, the presence of gaps was scored as 0 or 1, at five enamel and five dentin locations. Marginal gaps were present in 6% of all enamel locations and in 75% of all dentin locations investigated. The gap frequency was lowest at the enamel occlusal locations, it increased gradually toward the dentin, and attained the highest value at the gingival locations. In enamel, the occurrence of gaps was dependent on the DBA's but independent of the particular technique used. In dentin, there was significant difference in gap occurrence between DBA's with any of the incrementation techniques. The frequency of gap occurrence was not significantly changed by the incrementation techniques. The most effective single agent in producing gap-free restorations was the Gluma, and the most effective combination was the Gluma/Clearfil.

Cardiac status of adolescents tracking with high and low blood pressure since early childhood

The risk of cardiovascular disease for children in the upper percentiles of the blood pressure distribution for age has not been determined. In this study echocardiographic evaluation was conducted at age 15 years in eight children tracking in the 89 +/- percentile for systolic blood pressure since age 8 years, and compared with nine children tracking in the 28 +/- 3 percentile over the same period. No significant differences were observed for left ventricular size, septal or posterior wall thickness or relative wall thickness using raw data, after adjustment for body mass index or after regression analysis using systolic blood pressure as the dependent variable. In contrast, stroke volume, cardiac output and left ventricular fractional shortening were greater in the high blood pressure group after adjustment for body mass index (P = 0.006, 0.075 and 0.08, respectively). These results suggest that changes consistent with previously reported findings in adults with essential hypertension (i.e. and increase in cardiac performance with normal peripheral resistance) are also early findings in adolescents tracking with high blood pressure.

Electrolytes and blood pressure levels in childhood hypertension: measurement and change

Research into the relationship between dietary electrolytes and the primary cause and treatment of hypertension has now reached the stage where long-term, detailed, controlled, randomized, clinical trials of intervention need to be carried out among those at high risk, including children. Such trials must incorporate methods for estimating "sensitive" responders. The designs should also include precise measures of change in dietary electrolyte intake and allow for analysis of interaction of the effects of individual electrolytes. We have sketched the unforeseen errors, that now must be avoided, from earlier studies and given an outline of a current study that sets out to meet optimum requirements. It is to be hoped that many similar studies will soon be initiated in multiple population groups.

Test-retest reliability of the Minnesota Leisure Time Physical Activity Questionnaire

The test-retest reliability of the Minnesota Leisure Time Physical Activity Questionnaire was assessed by two administrations of the questionnaire at a five-week interval in 140 adults from a general population sample and at a two-week interval in 150 male participants in the Multiple Risk Factor Intervention Trial (MRFIT). In both study populations, there was a slight, nonsignificant drop in reported leisure time energy expenditure between the test and the retest. The largest test-retest differences in estimated energy expenditure were found among those reporting greater levels of energy expenditure. Nevertheless, in both study populations Spearman rank correlation coefficients between the test and retest were high--0.79 to 0.88 for total activity and ranging 0.69-0.86 among the light, moderate, and heavy intensity subcategories. The high reliability of the Minnesota Leisure Time Physical Activity Questionnaire corroborates its utility in epidemiologic research.

Leisure time physical activity and its relationship to coronary risk factors in a population-based sample. The Minnesota Heart Survey

Energy expenditure in leisure time physical activity was measured using the Minnesota Leisure Time Physical Activity Questionnaire in a probability sample of 25- to 74-year-old residents of the seven-county metropolitan area of Minneapolis-St. Paul, Minnesota. Geometric mean estimates of leisure time physical energy expenditure were 193 kcal per day for men and 111 kcal per day for women. Only 34% of men and 17% of women expended 2,000 kcal or more per week in leisure time physical activity. Energy expenditure, especially in heavy intensity activities, declined with age, more so for women than men. Significant associations were observed between leisure time physical activity, particularly heavy intensity activity, and other coronary heart disease risk factors. Greater heavy intensity activity was associated with higher education (r = 0.14 to 0.26), greater Type A behavior (r = 0.14 to 0.15), higher serum high density lipoprotein (HDL) cholesterol levels (r = 0.09 to 0.10), lower serum thiocyanate (r = 0.10 to -0.14), lower body mass index (r = -0.10 to -0.11), lower heart rate (r = -0.07 to -0.10), and lower systolic blood pressure (r = -0.06 to -0.09). Thus, although energy expenditure was generally low in this population, greater leisure time physical activity for the most part was associated with lower coronary risk factors.

Acute stroke in a metropolitan area, 1970 and 1980. The Minnesota Heart Survey

Mortality rates for stroke, and hospitalization and case fatality rates for acute stroke in 1970 and 1980 were obtained for residents aged 30-74 of the Twin Cities (Minneapolis--St Paul) metropolitan area to determine whether improved hospital care contributed to the decline in stroke mortality. Age-adjusted mortality rates per 100,000 declined significantly in that decade for men (1970, 89.4; 1980, 47.5; p less than 0.01) and women (1970, 72.6; 1980, 40.9; p less than 0.01). Age-adjusted hospitalization rates per 100,000 population also declined significantly for men (1970, 438; 1980, 323; p less than 0.01) and women (1970, 331; 1980, 203; p less than 0.01). Age-adjusted mean length of hospital stay did not change significantly. Hospital case fatality declined for men aged 30-64 years (1970, 22.5%; 1980, 15.1%; p less than 0.01) but did not change significantly for 65 to 74 year-old men (1970, 16.5%; 1980, 20.0%; p = 0.09) or for all women (age-adjusted rates: 1970, 13.6%; 1980, 16.0%; p = 0.17). There was no change in the distribution of severity of hospitalized cases between years. Therefore, the decline in stroke mortality is consistent with a decreased incidence of stroke resulting from improved hypertension control. Improvements in hospital medical care appear not to have contributed substantially to the decline in stroke mortality.

Personality, behavior, family environment, family social status and hypertension risk factors in children. The Minneapolis Children's Blood Pressure Study

To assess the relationship of psychosocial variables to risk factors for hypertension in children, we administered instruments designed to measure aspects of children's personality, behavior, family environment and family social status to 1505 school children aged 7-10 years. Children's blood pressure was significantly related only to mother's occupation, the children of unskilled employees having higher blood pressure than children of higher status workers. Children's body mass index was directly related to scores on the conformity scale of the personality inventory and inversely related to scores on the intellectual-cultural orientation scale of the family environment instrument and to social class. Social status but not measured dimensions of children's personality, behavior and family environment may influence the risk of hypertension in children.

Racial differences in personality, behavior, and family environment in Minneapolis school children

Racial differences in personality, behavior, and family environment of lower elementary school children were examined in a sample of 433 black and 897 white children. Numerous significant differences in scores on scales of the Missouri Children's Picture Series, the Missouri Children's Behavior Checklist, and the Family Environment Scale persisted after adjustment for socioeconomic status.