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PubMed2000

Comparison of computer-assigned Minnesota Codes with the visual standard method for new coronary heart disease events.

The Minnesota Code is the most widely used electrocardiogram (ECG) classification system for epidemiologic studies and has been incorporated into several Computer algorithms. The authors compared the Modular ECG Analysis System (MC-MEANS) and NOVACODE computer ECG findings with the Visual coding standard for agreement and prognostic associations with coronary heart disease (CHD) events occurring during follow-up from 1987 to 1995 in 2,116 individuals participating in the Atherosclerosis Risk in Communities (ARIC) Study. The exact agreement between Visual and computer findings was greater than 90% for all Minnesota Code categories except Q-code, which was 77% for MC-MEANS and 81% for NOVACODE. Approximately 60% of all Q-codes were assigned by computer methods only. Among the 2,116 participants, there were 246 (11.6%) new coronary events. Unadjusted relative risks for codes assigned by the three methods were similar. When computer methods disagreed on code severity, the CHD occurrence rates for MC-MEANS-detected severer code versus NOVACODE-detected severer code were 21% and 7%, respectively. This study provides clear evidence that computers assign more and severer Minnesota Codes with similar prognostic importance as does the Visual method; it also alerts researchers to potential problems in pooling Minnesota Code data read by different methods.

Algorithms↗
PubMed1988

Comparison of the opsonic activity of polyclonal and monoclonal antibodies raised against Salmonella minnesota strain R595.

Murine monoclonal antibodies and immune rabbit serum were raised against the rough mutant Salmonella minnesota strain R595. These antibodies were tested for their opsonic activity against the homologous strain and the smooth wild type S. minnesota by luminol-dependent chemiluminescence and a microscopic assessment of phagocytosis. Immune rabbit serum opsonised both strains. Treatment with normal rabbit serum inhibited the phagocytic uptake of S. minnesota R595. None of the monoclonal antibodies RE01 (anti-KDO), RE12 (anti-KDO) and RE23 (anti-lipid A) were opsonic. Unopsonised S. minnesota R595 stimulated marked chemiluminescence possibly because of its hydrophobic surface, but this was not reflected in increased uptake by phagocytic cells. Results obtained with luminol-dependent chemiluminescence should be interpreted with caution when the opsonisation of rough bacterial strains or those with high surface hydrophobicity is being investigated.

Animals↗
PubMed1988

The consequences of reviewing serial changes in the Minnesota code for diagnosis of acute myocardial infarction.

We investigated the effect of reviewing serial electrocardiograms (ECGs) for significance of changes in the Minnesota code, and the influence of this effect on the MONICA diagnosis of myocardial infarction (MI). We used the data from 1340 consecutive admissions to the coronary care units of our MONICA centre and we developed ECG classifications and MONICA diagnoses that were based once on the unreviewed Minnesota code and once on the reviewed code. A comparison of the two ECG classifications showed that codes for evolution of Q-waves and injury currents were much more likely to change as a result of a review (46.8%) than codes for evolution of repolarization changes (12.8%). The review of serial Minnesota codes caused a change of the MONICA diagnosis primarily in the category definite MI (10%). In a blinded clinical assessment, the cases that changed diagnosis were judged to be different from those that remained constant. It is concluded that the use of ECG classification based on unreviewed Minnesota code changes introduces heterogeneity. The significance of this effect depends on the use of the results.

Coronary Care Units↗
PubMed1989

Role of C1q in phagocytosis of Salmonella minnesota by pulmonary endothelial cells.

The Re mutant of Salmonella minnesota adheres in much greater numbers than the wild type to endothelial cells derived from the bovine pulmonary artery. Since the Re mutant is distinguished from wild-type S. minnesota by its ability to bind C1q and since endothelial cells possess receptors for C1q, we examined the role of C1q in the phagocytosis of the S. minnesota Re mutant. First, preincubating endothelial cells with C1q-enriched medium resulted in increased adherence of the Re mutant (17.9 x 10(4) versus 6.6 x 10(4]. Second, preincubating the Re mutant with C1q-enriched medium resulted in increased numbers of adherent bacteria (62.1 x 10(4) versus 6.6 x 10(4]. Preincubation of both endothelial cells and bacteria with C1q-enriched medium resulted in increased adherence above control levels but less adherence than when either cells or bacteria were preincubated separately in C1q-enriched medium. If serum depleted of C1q was used for preincubation of endothelial cells or bacteria, adherence was reduced below control levels. Thus, C1q plays an important role in the initial steps (recognition, binding, and ingestion) of phagocytosis. Next, the role of C1q was investigated in the respiratory burst response. Levels of superoxide anion released from endothelial cells 15 min after phagocytosis of the Re mutant (100 bacteria per endothelial cell) were assayed by measurement of the superoxide dismutase-inhibitable reduction of ferricytochrome c. Superoxide anion release was increased during phagocytosis of the Re mutant (35 nmol of O2- per 3 x 10(6) endothelial cells) and was also elevated above control values by incubation with soluble C1q (10 nmol of O2- per 3 x 10(6) endothelial cells). These results indicate a role for C1q in both the ingestion and the response of endothelial cells to the S. minnesota Re mutant.

Animals↗
PubMed1974

Genetic analysis of Salmonella minnesota R mutants with defects in the biosynthesis of the lipopolysaccharide core.

A set of R (rough) mutants, in which the synthesis of the cell wall lipopolysaccharide is defective, were analyzed genetically. These same Salmonella minnesota mutants have been used extensively in biochemical studies. By combining the information from all these studies, we obtained a complete genetic description of many of these mutants. Most of them turned out to be double rfe rfa mutants in which the rfe mutation (close to ilv) accounts for inability to synthesize O-specific structures and the rfa mutation accounts for defects in the synthesis of the core and, thus, for the lipopolysaccharide chemotype. These mutants demonstrate that in S. minnesota of O group L, as well as in S. typhimurium of the O group B, the rfb gene cluster close to his determines the synthesis of the O-specific side chain of the lipopolysaccharide, and the rfa genes in a cluster close to pyrE determine the synthesis of the lipopolysaccharide core. Phosphorylation of the core is determined by a rfaP gene also in this cluster and so far identified only by these S. minnesota mutants. In addition, the rfe gene(s) close to ilv is required for O-side chain synthesis in S. minnesota but not in S. typhimurium.

Cell Wall↗
PubMed2002

[Evaluation of the ECG in epidemiologic studies of cardiovascular diseases--the Minnesota code].

The authors evaluate the importance of the Minnesota code for description of the ECG curve in epidemiological surveys. The ECG tracing is not evaluated clinically but is only described and changes are summarized into categories marked arbitrarily as minor and major ischaemic changes. In these categories their predictive value is assessed on a longitudinal basis. It was revealed that minor and major ischaemic changes have a predictive value for cardiovascular morbidity and mortality similarly as other risk factors of ischaemic heart disease. The authors mention some epidemiological surveys where the Minnesota code was used. Assessment of the ECG tracing and its evaluation by the Minnesota code should be done by a person trained in this method. At present it is possible to use also computer evaluation of ECG tracings by the Minnesota code.

Czech Republic↗
PubMed1988

Minnesota ALG. Safe and effective immunosuppression for cardiac transplantation.

Fifty-six patients undergoing orthotopic cardiac transplantation were given Minnesota ALG prophylactically or therapeutically for acute cardiac rejection. During a follow-up period of 0-28 months (mean follow-up period, 11.9 months), the actuarial survival for the entire group was 96% and 86% at 30 days and 1 year, respectively. Actuarial freedom from rejection was 60% and 28% at 30 days and 1 year, respectively. All but seven rejection episodes responded to initial steroid pulses or a modification of a maintenance cyclosporine and azathioprine regimen. The seven failures were rescued with further Minnesota ALG therapy. Few serious hematologic or allergic reactions to Minnesota ALG were observed, and no new malignancies occurred during the follow-up period. We conclude that Minnesota ALG is safe and effective in cardiac transplantation.

Coronary Disease↗
PubMed1992

For better or worse? The moral and policy lessons of Minnesota's HealthRight legislation.

Minnesota's recently enacted HealthRight legislation places the state at the forefront of American health reform. How did the state manage to overcome the policy gridlock in evidence in other states and at the national level? And how well does the legislation fare under close ethical scrutiny? Among the most important factors that permitted Minnesota to enact reforms were the explicit linkage in the legislative debate of the goal of cost containment to the desire to expand access, the public perception that HealthRight is incremental and consistent with earlier reform efforts in Minnesota, and the lengthy public debate that preceded the enactment of HealthRight. Although it endeavors to create a fair and efficient health care system, it is not at all certain that HealthRight, in its present form, will achieve these normative goals.

Cost Control↗
PubMed1999

The tobacco industry and underage youth smoking: tobacco industry documents from the Minnesota litigation.

OBJECTIVE: To learn how underage youth have been regarded by the major tobacco companies, as revealed in industry documents during the Minnesota litigation. DATA SOURCES: Documents from Brown & Williamson Tobacco Corp, Lorillard Tobacco Co, Philip Morris Inc, and R. J. Reynolds Tobacco Co. STUDY SELECTION: Documents available from the State of Minnesota and Blue Cross and Blue Shield of Minnesota v Philip Morris Inc et al during the discovery process of the trial. Hundreds of industry documents related to youth, teenagers, and young adults were examined. A sample of documents are referenced as illustrations of key points. CONCLUSIONS: Underage youths are viewed by the tobacco industry as critical to its future. Underage youth smoking patterns were examined for decades. Reductions in youth smoking rates were seen by tobacco companies as a negative trend for the companies. Specific marketing campaigns were directed at underage youth and were successful with this age group. Tobacco industry practices should continue to be carefully scrutinized.

Adolescent↗
PubMed2003

Newborn length of stay, health care utilization, and the effect of Minnesota legislation.

OBJECTIVE: To describe newborn length of stay, postdischarge follow-up, and health care utilization in the context of Minnesota's early discharge legislation. DESIGN AND SETTING: Retrospective study using claims data from a large managed care organization. PARTICIPANTS: Term newborns born from January 1995 through February 1999 (N = 22 944). OUTCOME MEASURES: Newborn length of stay, home or clinic visits within 1 week of discharge (early follow-up), immunizations completed by age 3 months, readmissions within 1 month of discharge, and urgent care or emergency department visits within 2 months of discharge. RESULTS: After enactment of Minnesota's early discharge legislation in 1996, the percentage of newborns with short stays (0-1 days after vaginal birth or 2-3 days after cesarean birth) decreased from 52% to 16% for vaginally born infants and from 87% to 63% for cesarean-born infants (P =.001). Although the legislation mandated coverage for home visits after short stays, only 12.4% of short-stay newborns had early home visits. Overall, 50% of infants had early home or clinic follow-up; compared with those who did not receive early follow-up, these infants were more likely to have complete immunizations (adjusted odds ratio [OR], 1.09; 95% confidence interval [CI], 1.03-1.14), urgent care or emergency department visits (adjusted OR, 1.22; 95% CI, 1.07-1.39), and readmissions (adjusted OR, 2.49; 95% CI, 2.02-3.08). CONCLUSIONS: Although implementation of Minnesota's early discharge legislation corresponded with significantly increased lengths of stay, very few short-stay infants received the postdischarge care for which coverage was mandated. Our findings indicate, however, that infants at higher risk for adverse outcomes were appropriately identified to receive early follow-up.

Health Services Research↗
PubMed2003

Analysis of prevalence trends of autism spectrum disorder in Minnesota.

BACKGROUND: Alarming increases in the prevalence of autism spectrum disorder have been reported recently in the United States and Europe. OBJECTIVES: To quantify and characterize prevalence trends over time in autism spectrum disorder in Minnesota. METHODS: We conducted an age-period-birth cohort analysis of special educational disability data from the Minnesota Department of Children, Families & Learning from the 1981-1982 through the 2001-2002 school years. RESULTS: Prevalence rates of autism spectrum disorder rose substantially over time within single-age groups and increased from year to year within birth cohorts. Autism spectrum disorder prevalence among children aged 6 to 11 years increased from 3 per 10 000 in 1991-1992 to 52 per 10 000 in 2001-2002. All other special educational disability categories also increased during this period, except for mild mental handicap, which decreased slightly from 24 per 10 000 to 23 per 10 000. We found that federal and state administrative changes favoring identification of autism spectrum disorders corresponded in time with the increasing rates. CONCLUSIONS: We observed dramatic increases in the prevalence of autism spectrum disorder as a primary special educational disability starting in the 1991-1992 school year, and the trends show no sign of abatement. We found no corresponding decrease in any special educational disability category to suggest diagnostic substitution as an explanation for the autism trends in Minnesota. We could not assess changes in actual disease incidence with these data, but federal and state administrative changes in policy and law favoring better identification and reporting of autism are likely contributing factors to the prevalence increases and may imply that autism spectrum disorder has been underdiagnosed in the past.

Adolescent↗
PubMed1984

Malignant mesothelioma. The University of Minnesota experience.

Between 1950 and 1981, 31 patients with mesothelioma were treated at the University of Minnesota. An average of 0.2 to 0.6 patients were seen per year between 1950 and 1970, and since 1970 there has been an average of 1.4 to 2.4 patients per year. Twenty-seven of the 28 patients with malignant mesothelioma are known or presumed dead. Mesotheliomas occurred in all areas of Minnesota, and 28.6% of the patients had a definite history of asbestos exposure. This was also a probable cause of the disease in an additional 25% of patients. The clinical findings and course of the disease were similar to other series. The median survival of all patients was eight months. Doxorubicin-treated patients survived a median of 16 months (range, 2-36 months). Malignant mesothelioma is being increasingly recognized in Minnesota and has a grim prognosis in spite of doxorubicin therapy.

Adult↗
PubMed2006

Verified predominance of slow acetylator phenotype N-acetyltransferase 2 (NAT2) in a Hmong population residing in Minnesota.

Southeast Asians known as the Hmong have a high prevalence of tuberculosis and select cancers. The slow acetylation (SA) phenotype for N-acetyltransferase 2 (NAT2) has been associated with toxicity from the anti-tuberculosis drug, isoniazid and in increased risk of select cancers. Previous research indicates a 74.5% prevalence of SA in Hmong which differs from other Asian populations including the Japanese and Thai (range: 7%-45%). Given this contrast, the purpose of this study was to confirm or refute this unexpected predominance of the SA phenotype in Hmong. Unrelated, Minnesota Hmong between 18 and 65 years of age consented and participated by ingesting caffeine as the probe for NAT2. A urinary caffeine metabolic ratio AFMU/1X (<0.6) was used to classify subjects as slow acetylators. Among 51 analysable samples provided by 61 enrollees (27 male, 33 female, 1 sex unknown, age 30+/-11 years [mean+/-SD]) there were 47 (92.2%) slow and 4 (7.8%) rapid acetylators. The prevalence of the SA phenotype (92.2%) from this study exceeds the 74.5% (p<0.02 by chi-square test) previously noted in Minnesota Hmong (n=98). The predominance of the SA phenotype within Minnesota Hmong is confirmed. Further studies evaluating this unexpected prevalence, its genetic basis and potential clinical relevance to drug toxicity and disease are warranted.

Acetylation↗
PubMed2001

An analysis of serial Minnesota ECG code changes in the London cohort of the WHO Multinational Study of Vascular Disease in Diabetes.

AIMS/HYPOTHESIS: Deterioration and improvement in the electrocardiogram are important outcomes in cardiovascular disease progression assessment. We used a sample of serial records from the WHO Multinational Study of Vascular Disease in Diabetes (WHO MSVDD) to assess Minnesota coding variability. METHODS: A constructed subsample of 118 of the 352 paired (baseline and follow-up) and previously Minnesota-coded ECG records from the London cohort was randomised and re-read independently of the first code (respectively 11 and 0.5 years later) by the same two coders. Detailed Minnesota codes were summary coded into groups 1 (CHD unlikely), 2 and 3 (CHD possible and probable, respectively). RESULTS: Re-reading of the constructed sample for the baseline records (11 years later) generated 21 Summary code reassignments (2 unlikely to possible or probable; 19 possible or probable to unlikely); re-reading for the follow-up records (0.5 years later) generated only 8 summary code reassignments (21 vs 8p < 0.001) (3 unlikely to possible or probable; 4 possible or probable to unlikely; 1 probable to possible). Re-reading increased the estimated net ECG deterioration in the constructed sample from 11.8 % to 25.4%. Consistency analysis showed most variability in marginal baseline abnormalities. CONCLUSION/INTERPRETATION: Coding variability is now small though re-reading suggests some time-dependent coding drift. Relative over-reading at baseline suggests that the change reported in the complete WHO MSVDD cohort at follow-up was underestimated and that almost all of the reported ECG deterioration and about half of the reported ECG 'improvement' was real.

Cardiovascular Diseases↗
PubMed1985

Population risk of cardiovascular disease: the Minnesota Heart Survey.

A decline in age-adjusted ischemic cardiovascular disease mortality has been observed in the United States during the past two decades. Among the leading explanatory hypotheses is improvement in the major known risk factors for heart attack and stroke in the general population, specifically hypertension, smoking, and lipid levels. To better understand risk factor trends, the Minnesota Heart Survey (MHS) began systematic risk factor surveys of the Minneapolis-St Paul population in 1980, (population 1.99 million). The metropolitan area was divided into 704 subareas (clusters) of approx. 1000 households each, utilizing geographic boundaries. In a two-stage cluster sampling technique, 40 subareas were randomly chosen and mapped. Approximately 8.75% of households were chosen from each subarea and selected residents age 25-74 years invited to participate. A total 4451 individuals participated in 1980-82. The response rate for a home interview was 81.9 and 84.4% for a subsequent survey center visit, producing an overall response of 69.1%. The age and sociodemographic characteristics of the survey participants were similar to those found in the 1980 census. The prevalence of hypertension was 18.3% in this population with 76.0% taking medications and 65.0% controlled. Total cholesterol and HDL-cholesterol levels demonstrated age and sex differences similar to those reported elsewhere. Current smoking of cigarettes was equally prevalent in men (34.5%) and women (33.5%) although more men were former smokers (35.2 vs 20.6%). Comparison of the MHS with the National HANES II data (1976-80) indicates lower regular cigarette smoking among Minnesota males, with similar rates in females. Minnesota residents had better control of high blood pressure.

Adult↗
PubMed1988

A statewide approach to adolescent tobacco-use prevention: the Minnesota-Wisconsin Adolescent Tobacco-Use Research Project.

Adolescent smoking rates remain high and the use of smokeless tobacco is increasing, especially among males. Despite this continuing public health problem and the recent development of more effective prevention programs, few adolescents now participate in such programs at school. Recent legislation in Minnesota established guidelines for tobacco-use prevention programming and provides financial incentives to school districts to use more effective methods. The Minnesota-Wisconsin Adolescent Tobacco-Use Research Project has implemented an evaluation design that will provide data on the efficacy of this statewide approach to the prevention of tobacco use among adolescents. This article describes the current state of tobacco-use prevention programming in Minnesota schools, current efforts to improve on that record, and the research design set up to evaluate these strategies.

Adolescent↗
PubMed1994

Comprehensive evaluation of the Minnesota Leisure Time Physical Activity Questionnaire.

The accuracy of the Minnesota Leisure Time Physical Activity (LTPA) Questionnaire (a 1-year survey of non-occupational activity used in MRFIT) was studied in 78 men and women, age 20-59 years, by comparing survey results to the following measures obtained over a year's duration: six 48-hour physical activity records; fourteen 48-hour Caltrac accelerometer readings (Caltrac); 14 administrations of a 4-week version of the LTPA Questionnaire (FWH); 3 VO2peak determinations and percent body fat (% BF). The LTPA Questionnaire demonstrated: weak to moderate associations with % BF (r = -0.24) and with VO2peak (r = 0.47); a weak association with Caltrac readings expressed as MET.minutes.day-1 (r = 0.23); strong associations with corresponding activities reported on the FWH; and moderate associations with total and heavy activities reported in the physical activity record, but no associations with moderate and light activities. Furthermore, several types of LTPA were found to be either under-represented or not currently included in the Minnesota LTPA Questionnaire. It is concluded that although validation results were found to be quite good, several possible refinements were identified, which should improve the accuracy of the Minnesota LTPA Questionnaire in assessing habitual physical activity.

Adipose Tissue↗
PubMed2006

Compliance with restrictions on sale of indoor tanning sessions to youth in Minnesota and Massachusetts.

BACKGROUND: Minnesota and Massachusetts require parental permission, for persons younger than 16 or 18 years of age, respectively, for indoor tanning. OBJECTIVES: This report examines business practices and characteristics associated with sales of indoor tanning to underage girls. METHODS: Fifteen-year-old girls tried to purchase an ultraviolet tanning session in 200 indoor tanning businesses in the Minneapolis-St Paul and Boston areas without parental consent. Business characteristics were recorded. Later, businesses were interviewed by telephone about their facilities and practices. RESULTS: Eighty-one percent of businesses sold a session to an underaged buyer on at least one of two tries. Illegal purchases did not differ by state. Businesses least likely to sell were larger, dedicated to indoor tanning, required employee certification, and had a minimum age of sale for their business. However, businesses in each of these categories still sold tanning sessions to underaged adolescents at 44% to 62% of the visits. Employees who requested parental consent or age identification almost never sold a session. LIMITATIONS: Businesses in Minnesota and Massachusetts only were included. CONCLUSION: Minnesota and Massachusetts laws specifying a minimum age of sale for indoor tanning are ineffective.

Adolescent↗