PubMed Health⌕ Search

Biomedical subjects

R B Shekelle

Publications and source records attributed to R B Shekelle.

At least 73 records · Page 4Linked to original sources
PubMed1981

Psychological depression and 17-year risk of death from cancer.

Psychological depression, measured in 1957-1958 by the Minnesota Multiphasic Personality Inventory at the baseline examination of 2,020 middle-aged employed men, was associated (p less than 0.001) with a twofold increase in odds of death from cancer during 17 years of follow-up. The association did not vary appreciably in magnitude among the early (1958-1962), middle (1963-1968), and later (1969-1974) years of follow-up, persisted after adjustment for age, cigarette smoking, use of alcohol, family history of cancer, and occupational status, and was apparently not specific to any particular site or type of cancer. This result, predicted in advance on the basis of findings by other investigators, is consistent with the hypothesis that psychological depression is related to impairment of mechanisms for preventing the establishment and spread of malignant cells.

Adult↗
PubMed1981

Alcohol, cardiovascular risk factors and mortality: the Chicago experience.

The association between alcohol consumption and cardiovascular risk factors, the association between alcohol consumption and the incidence of high blood pressure, and the association between alcohol consumption and mortality, both all-cause and cause-specific, were examined in the white males from the Chicago Peoples Gas Company study and the Chicago Western Electric Company study. In both studies, there was a significant cross-sectional association between heavy alcohol use--defined as problem drinking in the Gas Company and as consumption of six or more drinks per day in the Western Electric Company--and the level of blood pressure and high blood pressure. In addition, in 1340 normotensive men ages 27-64 years from the Gas Company and in 871 normotensive men ages 40-55 years from the Western Electric Company, a significant prospective relationship was shown, for the first time, between heavy drinking and risk of developing high blood pressure. In the Gas Company, among 1233 men ages 40-59 years, 38 problem drinkers had significantly higher 15-year mortality from all causes, the cardiovascular diseases and coronary heart disease than the rest of the men. In the Western Electric study, 78 men who consumed six or more drinks per day had significantly higher 17-year mortality from all causes, the cardiovascular diseases and coronary heart disease, cancer and all other causes than the rest of all men.

Adult↗
PubMed1980

Fatal myocardial infarction and the role of oral contraceptives.

The association between use of oral contraceptives (OC) and death from myocardial infarction (MI) in young women was investigated in a collaborative case-control study conducted in the five largest metropolitan areas in the US. Potential cases were identified from computer tapes of the National Center for Health Statistics. Controls were selected from among women who died from, or were hospitalized for, acute conditions other than heart disease or from accidents, and were matched to cases on age, geographic area, and year of death. Information on cause of death, personal characteristics, OC use, and the presence of conditions predisposing to MI was obtained from interviews with relatives and abstracts of hospital, clinic and physician records. Odds ratios as approximations to relative risks for fatal MI in relation to OC use, and the associated 95% confidence limits, were calculated overall and for subgroups determined by demographic and health history characteristics. Odds ratios in the total study population were not significantly different from one. However, odds ratios significantly different from one were found when attention was restricted to white subjects without contraindications to OC use, andincluding only those cases whose deaths were attributed to MI with the greatest degree of certainty. Smoking was found to be a significant risk factor for fatal MI.

Adolescent↗
PubMed1980

Heart rate as a prognostic factor for coronary heart disease and mortality: findings in three Chicago epidemiologic studies.

The associations between heart rate and death from the cardiovascular diseases (CVD), coronary heart disease (CHD) and sudden death from CHD, along with death from all causes and non-cardiovascular causes, are examined for three groups of middle-aged white males: 1233 men aged 40-59 years followed for 15 years from the Chicago Peoples Gas Company study; 1899 men aged 40-55 years followed for 17 years from the Chicago Western Electric Company study; and 5784 men aged 45-64 years followed an average of five years from the Chicago Heart Association Detection Project in Industry. In univariate analyses, mortality from both cardiovascular and non-cardiovascular causes generally increases with increasing heart rate. In bivariate analyses, using the Cox regression model to control for age, heart rate is significantly related to mortality from all causes in each study, with the associations again due to both cardiovascular and non-cardiovascular causes. In multivariate Cox regression, controlling for age, blood pressure, serum cholesterol, cigarettes smoked per day and relative weight, heart rate is a significant risk factor for sudden CHD death and non-CVD death in two of the three studies, with the association with sudden death being U-shaped in one of the studies. Although heart rate may be an independent risk factor for sudden CHD death, the associations with other CVD death and non-sudden CHD death, in general, appear to be secondary to associations between heart rate and other cardiovascular risk factors.

Adult↗
PubMed1980

Experience in changing food habits of hyperlipidemic men and women.

In this study, the following were planned and tested: Methods of changing adult eating habits to conform with dietary principles for lowering serum lipids; a method to assess adherence to dietary modifications; and use of nutrition aides as instructors. Six slide-tape units--tested by individual, group, and self-teaching methods, and a combination of these--were effective as judged by such indicators as lowered serum cholesterol, reduced intake of saturated fat and dietary cholesterol, and increased intake of polyunsaturated fat. The Diet Achievement Score is an effective tool for assessing adherence. Nutrition aides proved useful in this study, when effectively supervised by professional nutritionists.

Black or African American↗
PubMed1979

Racial patterns of heart rate in an employed adult population.

This study explored racial patterns of heart rate in a large population of employed Chicagoans: 39,665 adults screened in Chicago firms between late 1967 and early 1973. Of these, 30,876 were white or black adults age 18--64 with complete data, and not on drug therapy for hypertension. Mean heart rates of young black men and women were significantly lower than mean heart rates of young white men and women. This difference was not present for the age groups 35 and older. The difference was present in both smokers and non-smokers; in normotensives and in persons with elevated blood pressure; and could not be explained by differences in relative body weight. The difference persisted after simultaneous adjustment for differences in the mean values of systolic blood pressure, relative weight, serum cholesterol, post-loaded plasma glucose, and number of cigarettes smoked per day.

Adolescent↗
PubMed1979

Uric acid: a risk factor for coronary heart disease?

The association between serum uric acid and the prevalence of ECG abnormalities was analyzed for 24.997 employed men and women, white and black, age 18--64 years, from the Chicago Heart Association (CHA) Detection Project in Industry. In addition, the relationships between uric acid and 5-year mortality from all causes, from cardiovascular diseases (CVD), and from coronary heart disease (CHD) were analyzed for 7804 white men and women age 45--64 years from this study and 967 white men age 44--63 years from the Chicago People's Gas Company Study. For men, the association between uric acid and the prevalence of ECG abnormalities and with mortality appear to be secondary to associations between uric acid and other risk factors. For women, however, the associations could not be explained by other risk factors.

Arrhythmias, Cardiac↗
PubMed1979

Evaluation of an automated blood pressure measuring device intended for general public use.

Responding to Chicago newspaper reports, measurements of blood pressure by a publicly available, automated coin-operated device were compared with those of human observers using the standard cuff and auscultatory technique. One machine was examined in the laboratory, and eight others at randomly selected sites. Analysis of readings made on 100 persons in the laboratory and 227 in the field led to the following conclusions: 1) On the average, the machines measured fifth phase diastolic blood pressure at nearly the same level as did human observers; 2) The machines were more variable measuring systolic blood pressure with four differing from the average human reading by 1mm Hg or less, but two differing by 8mm Hg or more; 3) The agreement between machine-human pairs of readings was not as good as between human-human pairs, but the differences in level of agreement--both in determining the actual value and in categorizing the values as normal, borderline, or high--were small and have little practical importance; 4) Linear regression analyses of the relationship between simultaneously determined machine and human readings indicated that the average human-machine difference was the same over the range of pressures tested. Publicly available blood pressure measuring devices should be labeled concerning their purposes, capabilities, and limitations. Rules and regulations governing their use in the City of Chicago are being prepared by this city's Legal Department.

Blood Pressure Determination↗
PubMed1978

Public beliefs about causes and prevention of heart attacks.

Interviews with a probability sample of 617 adults in the Chicago area indicated widespread lack of information about major probable causes of heart attacks in persons younger than 60 years: 28% named cigarette smoking, 21% named high blood pressure, and 13% named cholesterol or fat in the diet or blood. Half did not name any of these risk factors, and only 1% named all three. Although three fourths believed that heart attacks are preventable, few named specific behaviors that would effectively reduce risk factors other than smoking. Sustained community-wide educational programs about reducing coronary risk factors are clearly needed and can be effective.

Adult↗
PubMed1978

The "false negative" treadmill exercise test and left ventricular dysfunction.

One hundred and fifteen consecutive symptomatic patients undergoing graded exercise testing, selective coronary angiography and left ventriculography were retrospectively evaluated. The sensitivity, specificity, and false negative response rates of the exercise tests were 79%, 81%, and 21%, respectively. Although the magnitude of a positive ST-segment response was related to more extensive vascular disease, the frequency of false negative responses was nearly identical in patients with single, double, or triple vessel disease (22%, 21%, 19%). Analysis of the false negative group demonstrated significant ventriculographic and hemodynamic abnormalities when compared to the true positive responders. Five out of six patients with the most serious motion disorders in the study fell into the false negative group. There were no significant differences in the extent, distribution and severity of vascular involvement, or in the development of collateral circulation in the two groups. However, occluded vessels supplied abnormal ventricular segments more frequently in the false negative group (88% vs 38%); the absence of an "ischemic response" and the presence of segments of abnormal myocardium may be related. Left ventricular dysfunction appears to be an important reason for a false negative response to exercise.

Angiography↗
PubMed1977

Hypertension in the elderly.

The available data indicate that classical hypertension, defined here as a diastolic blood pressure greater than or equal to 95 mm Hg, is a widely prevalent and as important a risk factor for the cardiovascular diseases in those aged 65 and over as it is in those under 65. The limited available data also indicate that pure systolic hypertension, defined here as a systolic blood pressure exceeding 160 mm Hg with a diastolic pressure under 95 mm Hg, also very common at age 65 and over, is also related to excess cardiovascular morbidity and mortality in the elderly. However, it is not clear whether this latter relationship is indicative of cause and effect, or merely reflects the fact that in the elderly pure systolic hypertension is a sign of extensive sclerosis of large arteries. The results of Veterans Administration studies on antihypertensive therapy indicate that the elderly patient with classical hypertension is amenable to effective treatment, and that the benefits of such treatment significantly outweigh the risks. Great care is needed in the use of drugs for the management of hypertension in elderly patients, especially to minimize risk of hypotensive episodes and their possible harmful consequences; but with judicious and careful therapy, hypertension of this type can be controlled with reduction in excess risk of morbidity and mortality, at least for those with average diastolic pressures greater than or equal to 105 mm Hg. The lack of data on the benefits of treatment for those with pure systolic hypertension precludes any recommendations in regard to pharmacologic treatment of this condition.

Adult↗
PubMed1977

Alcohol consumption, cardiovascular risk factors, and mortality in two Chicago epidemiologic studies.

Multivariate analysis of the association at baseline between problem drinking and cardiovascular risk factors among 1,233 white male employees of the Chicago Peoples Gas Company age 40-59 showed the 38 problem drinkers with significantly higher blood pressures and cigarette consumption and significantly lower relative weights than the others. Similar analysis among 1,899 white male employees of the Hawthorne Works of the Western Electric Company in Chicago age 40-55 showed the 117 men consuming 5 or more drinks per day with significantly higher blood pressures and cigarette use than the others. No significant differences were recorded between heavy drinkers and the others in serum cholesterol level. The gas company problem drinkers had significantly higher 15-year mortality rates from all causes, cardiovascular diseases, coronary heart disease, and sudden death. These differences could not be entirely explained by their blood pressure, smoking, and relative weight status. The Western Electric heavy drinkers had increased 10-year mortality rates both for all causes and noncardiovascular causes.

Adult↗