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D R Jacobs

Publications and source records attributed to D R Jacobs.

At least 181 records · Page 10Linked to original sources
PubMed1991

Time trends in leisure-time physical activity in the upper midwest 1957-1987: University of Minnesota studies.

The assessment of leisure-time physical activity in four studies that used a similar questionnaire was carried out by the University of Minnesota between 1957-1960 and 1985-1987. Each study included adults living in the Upper Midwest. In men, age-adjusted leisure-time energy expenditure consistently increased over time, with the greatest increase occurring between 1957-1960 and 1974-1975. Much of this increase occurred in moderate and heavy intensity activity and was greater for white collar workers than for blue collar workers. The increase in the last period was similar for both classes of workers. Data were unavailable for women before 1980. Age-adjusted leisure-time physical activity in women also increased between 1980-1982 and 1985-1987. This increase was greater for blue collar than for white collar women. A major strength of these analyses is the last two surveys, which were specifically designed to assess time trends. Exact comparability of the earlier two surveys with the two latter surveys cannot be established; however, the use of the same detailed questionnaire across 30 years is unique. We conclude that leisure-time physical activity has been increasing for three decades, including substantial increases in vigorous activities.

Adult↗
PubMed1990

Cigarette smoking behavior is strongly related to educational status: the CARDIA study.

The prevalence and correlates of cigarette smoking were examined in 5,116 men and women ages 18-30 years including both blacks and whites of varied educational levels. Prevalence of smoking was approximately 30% in each race by gender subgroup after adjusting for age and education. The prevalence decreased with increasing education, from 54% among participants with less than a high school education to 12% among those with graduate degrees (P less than 0.001). Cessation rates followed a similar pattern, with former smokers twice as common among those with more education. Differences in smoking prevalence across occupational groups were largely explained by differences in educational achievement. More educated individuals smoked fewer cigarettes per day and chose brands with lower nicotine yield. Race and gender were not strongly related to smoking prevalence. However, among smokers, whites reported smoking 50% more cigarettes per day than blacks but the average nicotine and tar content of the cigarette was nearly three times higher among blacks than whites. The strong inverse relationship between education and cigarette smoking patterns has important implications for public health efforts directed at the prevention of cigarette smoking.

Adolescent↗
PubMed1990

Obesity and overweight in young adults: the CARDIA study.

The associations of body size with age, race, sex, and education in young adults were examined in 5,115 black and white, men and women ages 18-30 years. Black women were more obese than white women with greater mean levels of body mass index (25.8 vs 23.1 kg/m2), subscapular skinfold thickness (19.9 vs 15.2 mm), and waist girth (76.7 vs 72.0 cm), all P less than 0.0001. Black women were more likely to exceed 20% of ideal body weights (black women 23.7%, white women 9.1%, P less than 0.0001). No similar differences were found in men. Associations of measures of body size with age and education differed among race/sex groups. Body mass index and skinfolds increased with age among white and black men and black women, but not among white women. The association of education with obesity was negative among white women and positive among black men with no significant association noted among white men and black women. These data show a complex relationship between age, sex, race, education, and obesity in young adulthood.

Adolescent↗
PubMed1990

High density lipoprotein cholesterol as a predictor of cardiovascular disease mortality in men and women: the follow-up study of the Lipid Research Clinics Prevalence Study.

With data from the Lipid Research Clinics Prevalence Study used as a baseline, an average of 8.4 years of mortality follow-up has been completed for 8,825 male and female participants who were at least 30 years of age at the time of the study. The participants were examined at 10 North American sites during 1972-1976. Univariate findings for high density lipoprotein (HDL) cholesterol in the 7,569 persons initially free of coronary heart disease indicate an inverse relation with cardiovascular disease mortality for men and women. Controlling for age, low density lipoprotein (LDL) cholesterol, triglycerides, body mass index, systolic blood pressure, and smoking, multivariate analysis results indicate inverse relations between HDL cholesterol and cardiovascular disease mortality. In men, the cardiovascular disease mortality rate ratio for HDL cholesterol increments of 10 mg/dl was similar to the cardiovascular disease mortality rate ratio for LDL cholesterol increments of 30 mg/dl. In women, HDL cholesterol is more closely related to cardiovascular disease than is LDL cholesterol. HDL cholesterol is inversely related to both coronary heart disease and other cardiovascular disease mortality in both sexes, though the relation of HDL cholesterol with coronary heart disease mortality in women approached statistical significance only for the combined end point of suspect and definite cases. No relation was observed in either sex group between HDL cholesterol and noncardiovascular disease mortality. This study, only the second large prospective study evaluating the role of HDL cholesterol in women, confirms both the importance and the independence in both men and women of HDL cholesterol in the epidemiology of coronary heart disease and other cardiovascular disease mortality.

Adult↗
PubMed1990

Accuracy of death certificate diagnosis of intracranial hemorrhage and nonhemorrhagic stroke. The Minnesota Heart Survey.

The validity of death certificate diagnosis of stroke and its type as the underlying cause of death was investigated in a sample of in-hospital deaths of possible stroke cases from the Minnesota Heart Survey. The 228 in-hospital deaths in 1970 and the 180 deaths in 1980 had a stroke diagnosis either on hospital discharge records or as the underlying cause of death on the death certificate. Relative to a standardized physician diagnosis, positive predictive values for the death certificate diagnosis in 1970 were 96% for all types of stroke, 59% for intracranial hemorrhage, and 87% for nonhemorrhagic stroke. The respective values in 1980 were 100%, 82%, and 97%. An increase in positive predictive values, particularly for intracranial hemorrhage between 1970 and 1980, was attributed to the increased use of computerized tomography. Sensitivity for the death certificate diagnosis in 1970 was 63% for all types of stroke, 66% for intracranial hemorrhage, and 45% for nonhemorrhagic stroke. The respective sensitivities in 1980 were 70%, 76%, and 58%. The lower sensitivity for nonhemorrhagic stroke as compared with hemorrhagic stroke was due in part to 1) frequent reporting of nonhemorrhagic stroke as a contributing cause of death rather than the underlying cause of death and 2) time from stroke onset to death. Specificity among these possible strokes was high in both years. The low sensitivity of death certificate diagnosis of stroke may reduce estimated relative risks in epidemiologic studies. Nevertheless, since the advent of widespread use of computerized tomography, a death certificate diagnosis of intracranial hemorrhage versus nonhemorrhagic stroke appears to be sufficiently accurate for use in epidemiologic studies of stroke etiology.

Adult↗
PubMed1990

Comparison of two procedures for tracing participants in an epidemiologic cohort study.

The effectiveness and accuracy of using a commercial firm for tracing survey participants were compared with the results of an established, University of Minnesota tracing protocol. Studying a cohort of 622 survey participants ages 25-74 who were living in a single Midwestern community, we were unable to locate 142 (23%) at their original address after four years. We traced them according to the Minnesota protocol, using information obtained from contact persons (friends or relatives) and other sources. Overall, current address information was found for 96% of the participants lost to follow-up, and 113 (81%) of 139 addresses were supplied through the contact person. An independent attempt to obtain similar information using only credit bureau tracing through Associated Credit Services provided addresses for 123 of the participants. Associated Credit Services provided correct, current addresses for 39 (29%) of the 136 surviving participants (six fatal cases were excluded) and supplied correct, current addresses for a majority (58%) of the study participants found by protocol to be living in the study area and eligible for a follow-up clinic examination. We support the use of commercial services as secondary sources of address information in tracing participants after the initial use of contact persons to optimize participant contact. We recommend the use of commercial services as primary sources when contact persons are unavailable.

Adult↗
PubMed1990

Racial differences in serum cotinine levels among smokers in the Coronary Artery Risk Development in (Young) Adults study.

Cotinine was measured in the serum of nearly all 5,115 18-30 year old, Black and White, men and women participating in the Coronary Artery Risk Development in (Young) Adults Study, 30 percent of whom reported current cigarette smoking. Ninety-five percent of the reported smokers had serum cotinine levels indicative of smoking (greater than 13 ng/ml). The median cotinine level was higher in Black than White smokers (221 ng/ml versus 170 ng/ml; 95 percent CI for difference: 34, 65) in spite of the fact that estimated daily nicotine exposure and serum thiocyanate were higher in Whites. The difference persisted after controlling for number of cigarettes, nicotine content, frequency of inhalation, weekly sidestream smoke exposure, age, gender, and education. A reporting bias and nicotine intake were ruled out as explanations for the racial difference suggesting that the metabolism of nicotine or the excretion of cotinine may differ by race. Racial differences in cotinine levels may provide clues to the reasons for the observed lower cessation rates and higher rates of some smoking-related cancers in Blacks.

Adolescent↗
PubMed1989

A new epidemiologic classification system for interim myocardial infarction from serial electrocardiographic changes.

Many clinical trials or population studies have used change in Minnesota Q code, ST-segment depression code or T-wave inversion code as evidence of new myocardial infarction or new coronary heart disease event. Direct electrocardiogram (ECG) waveform comparison is a new standardized procedure for diagnosing interim myocardial infarction from ECGs classified according to the Minnesota code (serial Q-wave pattern change). This procedure was investigated for its application in epidemiologic studies. Use of this procedure in the Multiple Risk Factor Intervention Trial resulted in a 50% increase in the positive predictive accuracy, improved agreement with clinically defined myocardial infarction and a strong independent prognostic association with total and coronary heart disease mortality. Among those with major Minnesota Q-code findings, there was substantial variation in mortality. The 5-year coronary heart disease death rates estimated by life table analysis were 8.5% for those with major serial Q-wave pattern change, 5.1% for those with minor serial Q-wave pattern change and 1.5 to 2.6% for those with major or minor Minnesota Q-code change not substantiated by direct waveform comparison, compared with 2.4% for those with no Minnesota Q-code findings. The coronary heart disease death rate for those with major serial Q-wave pattern change was greater than that for the other ECG groups (p less than 0.01). Adjustment for age and other risk factors did not qualitatively alter these findings. This new approach is eminently suitable for export to other investigators, for incorporation into computer analysis programs and for statistical analysis.

Actuarial Analysis↗
PubMed1989

Serum cholesterol levels and six-year mortality from stroke in 350,977 men screened for the multiple risk factor intervention trial.

We examined the relation between the serum total cholesterol level and the risk of death from stroke during six years of follow-up in 350,977 men, 35 to 57 years of age, who had no history of heart attack and were not currently being treated for diabetes mellitus. The diagnosis of stroke and the type of stroke were obtained from death certificates. Using proportional-hazards regression to control for age, cigarette smoking, diastolic blood pressure, and race or ethnic group, we found that the six-year risk of death from intracranial hemorrhage (International Classification of Diseases, ninth edition [ICD-9], categories 431 and 432) was three times higher in men with serum cholesterol levels under 4.14 mmol per liter (160 mg per deciliter) than in those with higher cholesterol levels (P = 0.05 by omnibus test across five cholesterol levels). On the other hand, a positive association was observed between the serum cholesterol level and death from nonhemorrhagic stroke (P = 0.007). The inverse association of the serum cholesterol level with the risk of death from intracranial hemorrhage was confined to men with diastolic blood pressure greater than or equal to 90 mm Hg, in whom death from intracranial hemorrhage is relatively common. We conclude that there is an inverse relation between the serum cholesterol level and the risk of death from hemorrhagic stroke in middle-aged American men, but that its public health impact is overwhelmed by the positive association of higher serum cholesterol levels with death from nonhemorrhagic stroke and total cardiovascular disease (ICD-9 categories 390 through 459).

Adult↗
PubMed1989

An assessment of caloric intake as an indicator of physical activity.

Caloric intake has been suggested as a surrogate measure of physical activity, provided that energy balance is maintained. In this study we assessed caloric intake in relation to other measures of physical activity in a free-living population by a single 24-hr recall in white adult males, ages 22-79 years, examined in 1957-1960 as part of the U.S. Railroad Study. Intake was positively related to leisure time and occupational activity. Men with higher levels of caloric intake had lower exercise test heart rates indicating that they were probably more fit. Caloric intake was also significantly and inversely related to body mass index, the sum of the triceps and subscapular skinfold thickness measurements, blood pressure, and total serum cholesterol. These results suggest that caloric intake, even as measured in a 24-hr dietary recall, is an indicator of physical activity level. Therefore, caloric intake may be a useful indicator of physical activity in some population-based epidemiologic studies.

Adult↗
PubMed1989

Differences in smoking cessation strategies between men and women.

This descriptive research was designed to identify differences in smoking cessation strategies between men and women in a cross-sectional population sample of current smokers in the upper Midwest. Data on the number of previous quit attempts, the success and persistence in quit attempts, future intentions to change smoking habits, and strategies planned for cessation were obtained from 1669 smokers. Log-linear analyses controlling for age and the number of cigarettes smoked revealed significant gender differences. Men and women appear to approach smoking cessation differently. Women were more tentative and less committed to quitting smoking entirely. Women were also less successful in sustaining smoking cessation attempts for longer than one week. Efficacy expectations and differential attributions for failure were suggested as possible explanations for the results, however further research will be necessary to confirm or disconfirm these hypotheses.

Adult↗
PubMed1989

Diagnostic criteria for hospitalized acute myocardial infarction: the Minnesota experience.

Standardized diagnostic algorithms are needed for systematic surveillance of hospitalized acute myocardial infarction (AMI). Ambiguities in diagnostic classification are resolvable to the extent that objective information is available in the hospital chart. In this study of diagnostic algorithms, serum cardiac enzyme levels, especially creatine kinase total (CK-TOT) and creatine kinase myocardial band (CK-MB) isoenzyme, were most closely correlated with the physician-reviewer diagnostic assignment used for validation; chest pain and electrocardiographic findings were less closely correlated. In addition, a close relationship was noted between the clinician's diagnostic impression and testing procedures and the final hospital discharge diagnosis. Thus, the algorithm should include discharge diagnosis as a classification element. The algorithm for cases discharged as acute myocardial infarction should be very sensitive, tending to call cases acute myocardial infarction. Other discharge diagnoses may harbour some clinically unrecognized myocardial infarction cases; however, the algorithm for such cases should be restrictive and specific to minimize false positives. These findings indicate optimal ways of combining clinical characteristics to most completely and accurately identify cases of acute myocardial infarction based on hospital records examined in retrospect.

Algorithms↗
PubMed1989

Relation of body fatness and its distribution to cardiovascular risk factors in young blacks and whites. The role of insulin.

Persons whose body fat is distributed predominantly in the abdomen compared with the hips are at increased risk of several chronic diseases. This study examined the cross-sectional relation of percent body fat, computed from skinfold thickness, and fat distribution, measured by the waist-to-hip girth ratio, to physiologic cardiovascular risk factors in a biracial sample (blacks and whites) of young adults aged 18-30 years. The subjects were persons who were examined at baseline (1984-1986) in the Coronary Artery Risk Development in Young Adults Study in four US metropolitan areas. The two hypotheses tested were that 1) after adjusting for percent body fat, waist-to-hip girth ratio is associated with several physiologic risk factors, and 2) fasting concentrations of serum insulin partly explain such association. Percent body fat was significantly associated with all measured blood lipids, lipoproteins, apolipoproteins, uric acid, and blood pressure. Waist-to-hip girth ratio was significantly, although more weakly, associated in multivariate models with blood concentrations of triglycerides, high density lipoprotein (HDL) cholesterol, HDL2 cholesterol, apolipoproteins A-I and B, low density lipoprotein cholesterol (in women only), uric acid, and systolic blood pressure, but was not associated in either sex with total cholesterol, HDL3 cholesterol, or diastolic blood pressure. Fasting serum insulin concentrations were significantly associated with percent body fat (Pearson r = 0.45-0.53), waist-to-hip girth ratio (Pearson r = 0.18-0.27), and most of the physiologic risk factors. Inclusion of fasting insulin in multivariate models reduced, but rarely eliminated, associations between waist-to-hip girth ratio and the physiologic risk factors. These findings suggest that obese young adults, especially those with abdominal fat preponderance, carry a physiologic profile that places them at higher risk of cardiovascular disease, and that fasting insulin concentrations are only partly explanatory.

Adipose Tissue↗
PubMed1989

High-density lipoprotein cholesterol and cardiovascular disease. Four prospective American studies.

The British Regional Heart Study (BRHS) reported in 1986 that much of the inverse relation of high-density lipoprotein cholesterol (HDLC) and incidence of coronary heart disease was eliminated by covariance adjustment. Using the proportional hazards model and adjusting for age, blood pressure, smoking, body mass index, and low-density lipoprotein cholesterol, we analyzed this relation separately in the Framingham Heart Study (FHS), Lipid Research Clinics Prevalence Mortality Follow-up Study (LRCF) and Coronary Primary Prevention Trial (CPPT), and Multiple Risk Factor Intervention Trial (MRFIT). In CPPT and MRFIT (both randomized trials in middle-age high-risk men), only the control groups were analyzed. A 1-mg/dl (0.026 mM) increment in HDLC was associated with a significant coronary heart disease risk decrement of 2% in men (FHS, CPPT, and MRFIT) and 3% in women (FHS). In LRCF, where only fatal outcomes were documented, a 1-mg/dl increment in HDLC was associated with significant 3.7% (men) and 4.7% (women) decrements in cardiovascular disease mortality rates. The 95% confidence intervals for these decrements in coronary heart and cardiovascular disease risk in the four studies overlapped considerably, and all contained the range 1.9-2.9%. HDLC levels were essentially unrelated to non-cardiovascular disease mortality. When differences in analytic methodology were eliminated, a consistent inverse relation of HDLC levels and coronary heart disease event rates was apparent in BRHS as well as in the four American studies.

Adult↗
PubMed1989

Leisure time physical activity and coronary heart disease death. The US Railroad Study.

Seventeen to 20 years of mortality follow-up were used to study the relation of leisure time physical activity (LTPA) to coronary heart disease mortality and to all-cause mortality in white male US railroad workers (n = 3,043). This cohort was initially examined from 1957 to 1960, reexamined from 1962 to 1964, and followed until 1977 or death. LTPA was ascertained by a precursor of the Minnesota Leisure Time Physical Activity Questionnaire. The risk estimate for coronary heart disease death, after adjusting for age, was 1.39 for sedentary men who expended 40 kcal/wk in LTPA compared with very active men who expended 3,632 kcal/wk. This relation was attenuated by adjusting for other coronary heart disease risk factors, but it remained independent and significant. Caloric expenditure in light and moderate activity, as well as that performed in any intense activity, showed independent relations to cardiovascular death and all-cause mortality. Associations were slightly stronger in occupationally sedentary men. These results support the hypothesis that physical activity protects against death from coronary heart disease and all-cause mortality.

Coronary Disease↗