Jacob B. Keller

Venous Thromboembolism and Other Venous Disease in the Tecumseh Community Health Study

The prevalence and incidence of venous thromboembolism and other venous disease has been determined as part of a longitudinal study of health and disease in a Michigan community. When these data are extrapolated to 1970 U.S. census figures, a rough estimate of annual incidence of clinically recognized deep venous thrombosis is over 250,000 cases while that of superficial thrombophlebitis is over 123,000. An estimated 24 million US citizens have “significant” varicose veins while 6 to 7 million have stasis changes in the skin of the legs and 400,000 to 500,000 have or have had a varicose ulcer. The relatively high frequency of these conditions in the adult population of Tecumseh, Michigan, indicates that they represent several of the more common medical problems encountered by the practicing physician.

Epidemiological Studies of Cardiovascular Disease in a Total Community—Tecumseh, Michigan

Excerpt Much knowledge on the epidemiology of the various cardiovascular disorders, particularly coronary heart disease (1), has been gained in recent years. Data on prevalence, incidence, and mort...

Epidemiology of asthma and allergic rhinitis in a total community, Tecumseh, Michigan: IV. Natural history☆

Abstract The incidence and remission of allergic rhinitis and asthma were studied in 6,563 residents of Tecumseh, Michigan, who were examined on two occasions separated by an average interval of 4 years. The 4 year incidence of probable allergic rhinitis was 2 per cent for males and females, and the 4 year incidence of probable asthma was 1 per cent for both sexes. During this time interval the incidence of allergic rhinitis among males and females who previously had asthma was 3 per cent and 5 per cent, respectively. The incidence of asthma in persons who previously had allergic rhinitis was 1 per cent in males and 3 per cent in females. Remission occured in approximately 20 per cent of persons with asthma and 8 per cent with allergic rhinitis over a 2 year period. Either disease was as likely to remit if the other disease was present or not. Allergic rhinitis was more likely to remit when the duration was shorter than 5 years, while asthma remissions were not clearly influenced by duration. Persons with perennial allergic rhinitis were less likely to remit than those with seasonal symptoms.

Adult respiratory distress syndrome in neutropenic patients

The precise pathophysiologic mechanisms that cause the adult respiratory distress syndrome are unknown. Indirect evidence from human studies and extrapolations from animal models have suggested that phagocytic neutrophils are important in the pathogenesis of this disease. To further evaluate the role of neutrophils, the frequency of neutropenia in 18 bacteremic patients who had the adult respiratory distress syndrome was compared with that in a control group who had bacteremia alone. Three of 18 patients in the group with the adult respiratory distress syndrome were neutropenic as opposed to one of 18 in the control group (p greater than 0.6). Histologic examination of the lungs from two patients with the adult respiratory distress syndrome and neutropenia demonstrated the absence of neutrophils. It is likely that there are many pathways that lead to the adult respiratory distress syndrome. Although neutrophils may be involved in some of these processes, this study demonstrates that neutrophils are not required for the development of the syndrome. In the appropriate clinical setting, the diagnosis of the adult respiratory distress syndrome should not be excluded solely because of neutropenia.

Habitual physical activity and blood pressure.

ABSTRACTHabitual physical activity of about 1,700 males, age 16 years and over, in a total community was assessed by questionnaire and interview. Systolic and diastolic blood pressure was recorded as part of their medical examination. The present analysis is concerned with the relationship between h

Cardiovascular risk factors and obesity: are baseline levels of blood pressure, glucose, cholesterol and uric acid elevated prior to weight gain?

The increased risk of cardiovascular morbidity and mortality experienced by the obese may be partially mediated through alterations induced in other associated risk factors. The attribution of this cardiovascular risk to obesity presumes that levels of those risk factors are not elevated independently of, or prior to, weight gain. We therefore examined baseline levels of blood pressure, glucose, cholesterol, and uric acid within age and sex specific strata of a population of 4015 individuals followed an average of 15 years to determine if an increasing level of fatness (weight/height 2) at follow-up was associated with elevation of other risk factors at baseline. After controlling for baseline fatness we were unable to demonstrate any consistent relationship between future fatness and baseline elevation of any of the factors. The magnitude of the partial correlation coefficients for those age 6-24 or 25-65 years at baseline were less than 0.11 for all of the risk factors. While a metabolic predisposition may link obesity to alterations of other risk factors it appears unlikely that their elevation commonly precedes weight gain. A pre-existing elevation of risk factors has not resulted in the misattribution of cardiovascular risk to obesity.

The Tecumseh Study

The Tecumseh Community Health Study has been described in terms of its history, aims, design, conduct and current results, work in progress and future plans. This prospective epidemiological investigation of health and disease, especially cardiovascular disease and related disorders, in a total, natural community has its emphasis on the early detection of disease precursors in susceptible individuals, families, and other groups; the outlook is on prevention. An extensive and intensive study of this kind has been shown to be both feasible and productive. It represents what Dr. Thomas Francis, Jr., has called “clinical investigation on a community level,” including data on man and his environment. The key contribution of Dr. Francis in the establishment and conduct of the study is recalled and remembered with deep appreciation and respect.

Cholesterol, coronary heart disease, and total mortality in middle-aged and elderly men and women in Tecumseh

Relationships between serum cholesterol and coronary heart disease (CHD) were investigated in Tecumseh men and women who were 45 to 92 years old and initially free of CHD. Recruitment continued through three cycles of examinations over a period of 10 years, beginning in 1959. Follow-up for mortality ended in 1986 to 1987. Age-adjusted relative risks for CHD death for cholesterol levels of 5.2 to 6.2 mmol/L and greater than 6.2 mmol/L, compared with levels less than 5.2 mmol/L for men aged 45 to 64 years, were 1.2 and 1.7; for older men they were 1.0 and 1.8. Comparable relative risks for CHD death by cholesterol level were .7 and 1.4 for 45- to 64-year-old women and .8 and .7 for older women. Coefficients for cholesterol were significant for fatal CHD in men under and those 65 years and older when age, systolic blood pressure, body mass index, cigarette smoking status, and glucose intolerance were controlled in proportional hazards models. Cholesterol was a significant predictor of fatal CHD plus nonfatal myocardial infarction in middle-aged, but not elderly women. Relative risks for total mortality were lowest for middle-aged men and women with cholesterol levels of 5.2 to 6.2 mmol/L and the difference was significant in men.

Habitual Physical Activity and Glucose Tolerance: Males Age 16–64 in a Total Community

The data being reported are part of an epidemiologic study of health and disease in an entire community, Tecumseh, Michigan. Approximately 1,300 males age 16–65 were classified into three groups on the basis of their habitual leisure and occupational physical activity. A blood sample was drawn one hour after a glucose challenge and analyzed for glucose concentration. A measure of body fatness (sum of four skinfolds) was also available on the men. Glucose concentration of the three physical activity groups was compared by analyses of variance within narrow age groups. There was no significant relationship between glucose tolerance and habitual physical activity. There was a slight, but in some age groups significant, relationship between glucose tolerance and body fatness. The population was then divided within each age group into subgroups (thirds) by sum of skinfolds. The analysis was repeated in each age-fatness group. Glucose tolerance was better in the active men but only among the leanest subgroup of subjects.

Effects of Cooking Fuels on Lung Function in Nonsmoking Women

A case-control study of 20- to 39-yr-old female participants in the Tecumseh Community Health Study compared use of cooking fuels and other factors in women from the highest and lowest quartiles of the lung function distribution. The forced expiratory volume in 1 second (FEV1.0) was used as the index of ventilatory lung function. The use of a kitchen exhaust fan was significantly associated with low lung function. A larger proportion of women with low FEV1.0 used gas for cooking, but this difference was not statistically significant.