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Biomedical subjects

C A Macera

Publications and source records attributed to C A Macera.

At least 55 records · Page 3Linked to original sources
PubMed1996

Education, health behaviors, and the black-white difference in waist-to-hip ratio.

Few epidemiologic studies have investigated the impact of body mass index, low educational attainment, cigarette smoking, and physical activity on the considerable black-white difference in waist-to-hip ratio. These relationships were assessed with multivariable linear regression among 3,094 adults (24% black) who were examined in 1987 in South Carolina. The unadjusted mean waist-to-hip ratio was lower for black men than for white men (-0.03 units) and higher for black women than for white women (+0.03 units). After adjustment for age, body mass index, education, smoking, and physical activity, the black-white difference in mean waist-to-hip ratio was -0.02 units (p < 0.001) among men and +0.01 units (p < 0.01) among women. Although differing distributions of age, body mass index, and educational attainment accounted for a 59% reduction in the black-white difference among women, these factors did not explain the difference among men. Thus, these results suggest that other environmental or biologic factors may also play an important role in the marked variation in body fat distribution between the two ethnic groups. The results also support the importance of the prevention of cigarette smoking and overweight in potentially preventing abdominal obesity in both black adults and white adults.

Adult↗
PubMed1996

Trends in mortality and health behaviors: status of white and African-American women.

A substantial proportion of mortality in the United States can be attributed to three major behaviors: using tobacco, maintaining an unhealthy diet, and being physically inactive. Using data from the South Carolina mortality files and Behavioral Risk Factor Surveillance System we were able to document state trends in mortality, cigarette smoking, physical inactivity, and unhealthy dietary practices. We found that, in spite of the declines in heart disease and stroke mortality noted nationally and in the state, the risk factor profiles for most women in South Carolina did not improve. This analysis further suggests that physical inactivity and dietary issues (excess caloric intake, low fruit and vegetable consumption) would be good choices for lifestyle interventions among women in South Carolina, not only because they ultimately affect mortality, but also because they exert interim effects on morbidity, including physical functioning and independence.

Black or African American↗
PubMed1995

Predictors of adopting leisure-time physical activity among a biracial community cohort.

Literature on the correlates and predictors of leisure-time physical activity among African-American population is sparse. This cohort study assessed correlates of leisure-time physical activity (specific large muscle activities during the past month at least three times a week) in a biracial population in 1987 and predictors for the adoption of this behavior 4 years later among those initially inactive. Random digit dialing methods were used to identify residents of two South Carolina communities in 1987. In 1991, 3,223 of these residents were resurveyed (62% response rate). In general, the correlates of leisure-time physical activity (education, > or = 12 years; nonsmoking; weight loss behaviors; and physician advice) were similar for each sex and race group. In 1987, the definition of leisure-time physical activity was not met by 831 (54% of 1,542) white women, 374 (76% of 489) African-American women, 586 (59% of 991) white men, and 126 (63% of 201) African-American men. Among those who were inactive in 1987, 22-24% of white adults and African-American men and 14% of African-American women adopted physical activity 4 years later. Twelve years or more of education was a predictor among white women (risk ratio = 1.7, 95% confidence interval 1.2-2.6) and African-American women (risk ratio = 3.1, 95% confidence interval 1.4-6.9), but not among men. Having a physician discuss physical activity was a predictor among white women (risk ratio = 1.9, 95% confidence interval 1.3-2.7), African-American women (risk ratio = 1.7, 95% confidence interval 0.9-3.2), white men (risk ratio = 2.0, 95% confidence interval 1.3-3.1), and African-American men (risk ratio = 2.7, 95% confidence interval 1.0-7.6). These results highlight the strong effect of educational attainment on adoption of healthy behaviors and support the involvement of physicians to promote physical activity among all race and sex groups.

Adult↗
PubMed1995

Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men.

OBJECTIVE: To evaluate the relationship between changes in physical fitness and risk of mortality in men. DESIGN: Prospective study, with two clinical examinations (mean interval between examinations, 4.9 years) to assess change or lack of change in physical fitness as associated with risk of mortality during follow-up after the subsequent examination (mean follow-up from subsequent examination, 5.1 years). SETTING: Preventive medicine clinic. STUDY PARTICIPANTS: Participants were 9777 men given two preventive medical examinations, each of which included assessment of physical fitness by maximal exercise tests and evaluation of health status. MAIN OUTCOME MEASURES: All cause (n = 223) and cardiovascular disease (n = 87) mortality. RESULTS: The highest age-adjusted all-cause death rate was observed in men who were unfit at both examinations (122.0/10,000 man-years); the lowest death rate was in men who were physically fit at both examinations (39.6/10,000 man-years). Men who improved from unfit to fit between the first and subsequent examinations had an age-adjusted death rate of 67.7/10,000 man-years. This is a reduction in mortality risk of 44% (95% confidence interval, 25% to 59%) relative to men who remained unfit at both examinations. Improvement in fitness was associated with lower death rates after adjusting for age, health status, and other risk factors of premature mortality. For each minute increase in maximal treadmill time between examinations, there was a corresponding 7.9% (P = .001) decrease in risk of mortality. Similar results were seen when the group was stratified by health status, and for cardiovascular disease mortality. CONCLUSIONS: Men who maintained or improved adequate physical fitness were less likely to die from all causes and from cardiovascular disease during follow-up than persistently unfit men. Physicians should encourage unfit men to improve their fitness by starting a physical activity program.

Adult↗
PubMed1995

Physical activity and public health. A recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine.

OBJECTIVE: To encourage increased participation in physical activity among Americans of all ages by issuing a public health recommendation on the types and amounts of physical activity needed for health promotion and disease prevention. PARTICIPANTS: A planning committee of five scientists was established by the Centers for Disease Control and Prevention and the American College of Sports Medicine to organize a workshop. This committee selected 15 other workshop discussants on the basis of their research expertise in issues related to the health implications of physical activity. Several relevant professional or scientific organizations and federal agencies also were represented. EVIDENCE: The panel of experts reviewed the pertinent physiological, epidemiologic, and clinical evidence, including primary research articles and recent review articles. CONSENSUS PROCESS: Major issues related to physical activity and health were outlined, and selected members of the expert panel drafted sections of the paper from this outline. A draft manuscript was prepared by the planning committee and circulated to the full panel in advance of the 2-day workshop. During the workshop, each section of the manuscript was reviewed by the expert panel. Primary attention was given to achieving group consensus concerning the recommended types and amounts of physical activity. A concise "public health message" was developed to express the recommendations of the panel. During the ensuing months, the consensus statement was further reviewed and revised and was formally endorsed by both the Centers for Disease Control and Prevention and the American College of Sports Medicine. CONCLUSION: Every US adult should accumulate 30 minutes or more of moderate-intensity physical activity on most, preferably all, days of the week.

Adult↗
PubMed1995

The impact of changes in coffee consumption on serum cholesterol.

To investigate the possible association between changes in coffee consumption and serum cholesterol levels, information was obtained from 2109 healthy nonsmokers aged 25-65 years at two clinic visits to a preventive medical center between 1987 and 1991 (mean interval between visits: 16.7 months). After adjusting for age and changes in other potential confounders, about 2 mg/dl total cholesterol increase was associated with an increase of one cup of regular coffee per day (p < 0.001). A dose-response was found among those who decreased regular coffee consumption, those who continued the same dose, and those who increased consumption. The same trend was observed among those who quit drinking regular coffee, those who never drank coffee, and those who started to drink coffee. No change in cholesterol level was found among those continuing to consume the same quantity of regular coffee compared to those who never drank coffee. The change in cholesterol level was not related to consumption of decaffeinated coffee, regular tea, decaffeinated tea, or cola with caffeine. To our knowledge, this is the first follow-up study correlating change in coffee consumption with change in serum cholesterol in a large group of men and women.

Adult↗
PubMed1994

Total cholesterol and high density lipoprotein cholesterol as important predictors of erectile dysfunction.

Although erectile dysfunction is frequently seen in patients with manifestations of arteriosclerotic disease, the independent contribution of serum cholesterol in predicting erectile dysfunction is unclear. The aim of this study was to examine the relation between serum cholesterol and erectile dysfunction. Medical histories, physical examinations, and blood tests were obtained at Cooper Clinic, Dallas, Texas, from 3,250 men aged 26-83 years (mean, 51 years) without erectile dysfunction at their first visit, who had one more clinic visit, all between 1987 and 1991. These men were followed 6-48 months after the first clinic visit (mean, 22 months). Erectile dysfunction was reported in 71 men (2.2%) during follow-up. Every mmol/liter of increase in total cholesterol was associated with 1.32 times the risk of erectile dysfunction (95% confidence interval 1.04-1.68), while every mmol/liter of increase in high density lipoprotein cholesterol was associated with 0.38 times the risk (95% confidence interval 0.18-0.80). Men with a high density lipoprotein cholesterol measurement over 1.55 mmol/liter (60 mg/dl) had 0.30 times the risk (95% confidence interval 0.09-1.03) as did men with less than 0.78 mmol/liter (30 mg/dl). Men with total cholesterol over 6.21 mmol/liter (240 mg/dl) had 1.83 times the risk (95% confidence interval 1.00-3.37) as did men with less than 4.65 mmol/liter (180 mg/dl). Those differences remained essentially unchanged after adjustment for other potential confounders. The authors conclude that a high level of total cholesterol and a low level of high density lipoprotein cholesterol are important risk factors for erectile dysfunction.

Adult↗
PubMed1994

Community intervention and trends in dietary fat consumption among black and white adults.

OBJECTIVE: This study assessed whether a state public health department could effectively implement an affordable nutrition intervention program at the community level. DESIGN: Cross-sectional data were collected via telephone surveys of 9,839 adults, aged 18 years or older, in 1987, 1989, and 1991 in two South Carolina communities. Nutrition education programs began in 1988 in one community. The other community served as a comparison site. We assessed and compared changes in community levels of dietary fat and weekly meat consumption, salt use, and nutrition promotion awareness with analysis of covariance regression techniques that included race, sex, and age as covariates. RESULTS: We observed favorable changes in most eating behaviors and levels of awareness in both communities. The intervention community experienced greater absolute changes that the comparison community in use of animal fats (-8.9% vs -4.0%; P = .02) and liquid or soft vegetable fats (+8.4% vs +3.6%; P = .04), and in awareness of restaurant nutrition information (+33.0% vs +19.4%; P = .0001). Although the primary type of dietary fat used differed between black and white respondents, we observed significant change among both groups. CONCLUSIONS: These results suggest that community-wide nutrition education programs may have augmented regional or national changes in dietary behavior among white and black adults in the intervention community.

Adult↗
PubMed1994

Correlates of high-density lipoprotein cholesterol in black and white women.

The relationships of high-density lipoprotein (HDL) cholesterol with body composition, leisure-time physical activity, cigarette smoking, and education were examined in a community-based sample of 480 Black and 1337 White women. Univariate and multivariate analyses indicated inverse associations of HDL with body mass index and waist-to-hip ratio in both groups, and with cigarette smoking and low educational attainment among White women only. Since correlates of HDL cholesterol differ for Black and White women, further investigation of the differences in these correlates is warranted.

Adult↗
PubMed1994

Epidemiology of Alzheimer's disease.

In summary, while only a few risk factors for Alzheimer's disease have been identified, several large collaborative studies of elderly populations are currently underway. As measurement techniques improve, the ability to diagnose this disease in its early stages will make the search for risk factors more feasible.

Aged↗
PubMed1994

Physical activity and health profiles of United States women.

Now that there is significant evidence to support the role of physical activity in the prevention of several chronic diseases and conditions, it is very important to encourage women to be active and to study the gender-specific benefits and risks of physical activity. The Year 2000 Objectives and the United States Preventive Services Task Force recommendations provide direction for clinical and public health efforts in the area of physical activity promotion. Evaluation of potential barriers for women to becoming more physically active is necessary to facilitate the design of physical activity promotion strategies and interventions. The medical and public health communities should collectively seek greater resources for additional research to better clarify the health benefits and risks of physical activity for women.

Adolescent↗
PubMed1994

Survival of Alzheimer's disease patients with regard to pattern of care in South Carolina, 1988-1993.

The length of time from diagnosis of AD to death was compared among three groups of AD patients in South Carolina. Each group received a different pattern of care. The survival time from diagnosis to death was longest among those who lived in institutions (mean three years for men, 4.6 years for women), and shortest among those who lived alone in the community (1.7 years for men, two years for women). The longer survival time of those who receive care (either in the community or in facilities) suggests that persons with AD benefit from personal attention to health needs. Providing additional support to family members of those with AD could help patients remain in the community longer, thus maintaining quality of life. For those who have no support in the community, efforts should be made to increase access to facilities.

Aged↗
PubMed1993

Body mass and risk of hip fracture among a national cohort of postmenopausal white women: a reanalysis.

To assess the prospective relationship between body mass and rate of hip fracture, we analyzed data from 2,285 postmenopausal women, aged 50-77 years, who responded to the first National Health and Nutrition Examination Survey (NHANES I) in 1971-1974 and the 1982-84 interview of the National Health Epidemiologic Follow-up Study (NHEFS). We plan to add to the previous analysis of these same data by Farmer et al. by 1) including retrospective information on estrogen replacement therapy; 2) increasing the follow-up time by 5 years and using only hospital-verified cases of hip fracture from the 1987 Health Care Facilities Stay data tape; and 3) limiting the analysis to postmenopausal white women, ages 50-77 years. Results of the multivariable Cox regression modeling showed that women with a baseline body mass index in the highest quartile (> 37 kg/m1.5) experienced a 70% lower rate of hip fracture compared with women in the lowest quartile (< or = 28.7 kg/m1.5)(RR=0.32; 95%CI:0.12, 0.82). Age was positively related to the risk of hip fracture, with the rate over 20% higher per year of age (RR=1.21; 95%CI:1.13, 1.29). Although reported education level, smoking history, physical activity level, and estrogen replacement were significantly (p < 0.0001) associated with body mass index, these covariates were not related to hip fracture in the multivariable analysis. Our findings corroborate earlier results using this same data source, and suggest that interventions aimed at preserving lean mass and consequent bone integrity should be encouraged among women before menopause and maintained through older adulthood.

Age Factors↗
PubMed1993

Oral contraceptive use and breast cancer in Indonesia.

A hospital-based case-control study was conducted in Ujungpandang, Indonesia, to determine the association of breast cancer and current and former oral contraceptive (OC) use. This study included 119 newly diagnosed, histologically-confirmed, breast cancer cases who were admitted to the four largest referral hospitals in Ujungpandang from 1990-1991. Controls were 258 women admitted to these same four hospitals with diagnoses unrelated to breast cancer or OC use. Thirty cases (32%) and 55 (19%) controls reported having ever used OCs. The odds ratio for ever using OCs and breast cancer was 1.8 (95% confidence interval 1.2-3.0) after adjustment for age, age at first pregnancy, and family history of breast cancer. Increasing duration of OC use did not increase risk of breast cancer. No latency trend of increasing years since first OC use among cases was observed; however, a younger age at first OC use was associated with increasing breast cancer risk. A significant recency effect was observed; women last using OCs within five years of study enrollment were at greatest risk of breast cancer (OR = 4.9, 95% CI: 2.1-11.4). This first study of breast cancer and OC use in Indonesia does not provide consistent data to indicate an increased risk of breast cancer associated with OC use. Although breast cancer cases were 80% more likely to have ever used OCs, neither duration nor latency of OC use were associated with cancer risk. The significant recency effect suggests that a detection bias might explain the observed relationship between ever OC use and breast cancer.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

The association of positive and negative events with depressive symptomatology among caregivers.

A pilot study of eighty-two caregivers was conducted in South Carolina in 1991 to identify positive and negative factors associated with caregiving. Through home visits, interviewers obtained data on a variety of physical and mental health measures, including two new scales designed to measure perceived "positive" and "negative" events that had occurred in the previous month. The Center for Epidemiologic Studies Depression scale was used as a measure of depressive symptomatology. For the new scales, only items that were significantly correlated with depressive symptomatology (p < 0.01) were retained. The new "positive" event scale (8 items) and the new "negative" event scale (16 items) had alpha coefficients of 0.79 and 0.86, respectively. These scales may be useful to researchers in sorting out mediating factors related to the burden of caregiving and in providing points for intervention.

Adaptation, Psychological↗
PubMed1993

A measure of perceived burden among caregivers.

This report describes an easily administered scale for measuring perceived burden among caregivers of family members with dementia. During home interviews conducted in 1991, 82 caregivers rated their family member with dementia on several items related to functional ability, the type of care provided, and associated stress. The resulting measure of perceived burden, based on 15 internally consistent items (alpha = 0.87), is significantly correlated with depressive symptomatology (r = 0.38, p = 0.0004). This measure is useful in assessing perceived stress associated with specific caregiving responsibilities. It can be used, along with other measures of patient functional status, to assess overall caregiver burden and to target intervention strategies.

Black or African American↗