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S J Jacobsen

Publications and source records attributed to S J Jacobsen.

At least 109 records · Page 6Linked to original sources
PubMed1996

Free, complexed, and total serum prostate-specific antigen concentrations and their proportions in predicting stage, grade, and deoxyribonucleic acid ploidy in patients with adenocarcinoma of the prostate.

OBJECTIVES: Nearly half of men with clinically localized prostate cancer are understaged. We evaluated whether knowledge of preoperative free prostate-specific antigen (f-PSA), complexed (c-PSA), and total (t-PSA) concentrations or the ratios thereof (f-PSA/t-PSA, c-PSA/t-PSA, and f-PSA/c-PSA) could improve upon the staging of prostate cancer when compared with standard PSA testing (t-PSA). In addition, we examined their associations with tumor grade and deoxyribonucleic acid (DNA) ploidy. METHODS: Two hundred ninety patients with prostate cancer, 178 (61%) of whom were treated with radical prostatectomy, formed the study group. RESULTS: Although there were significant differences in the f-PSA concentrations with respect to clinical stage, considerable overlap in PSA levels among the clinical substages was observed. Statistically significant differences but weak correlations were observed between the individual f-PSA, c-PSA, and t-PSA concentrations with regard to pathologic stage (organ-confined versus extraprostatic) and grade. No significant relationship, however, was observed with the three ratios. Higher PSA values were not always associated with a pathologic stage of pT3 or greater, and lower levels did not ensure that a tumor was organ-confined. Only a slight association was observed between c-PSA and t-PSA levels and DNA ploidy. No significant relationship was observed between the f-PSA levels as well as the three ratios with regard to DNA ploidy. A statistically significant improvement in predicting pathologic stage was observed when combining knowledge of preoperative t-PSA concentration with the c-PSA/t-PSA ratio. However, the area under the receiver operator characteristic curves was only slightly increased; as such this combination was of limited clinical utility. CONCLUSIONS: Statistically significant but weak correlations were observed between the molecular forms of PSA and stage, grade, and DNA ploidy. The significant overlap in f-PSA and c-PSA values among all stages, grades, and ploidy values precluded any useful predictive information for the individual patient. As such, preoperative knowledge of f-PSA and c-PSA values and the three ratios provided no additional diagnostic information over standard PSA (t-PSA) values alone.

Adenocarcinoma↗
PubMed1996

Ejaculation increases the serum prostate-specific antigen concentration.

OBJECTIVES: To determine the effect of ejaculation on the serum prostate-specific antigen (PSA) concentration in men at risk for developing prostate cancer. METHODS: A prospective, community-based study was conducted in which 64 men, aged 49 to 79 years, underwent a serum PSA determination immediately before ejaculation (baseline) and at 1 hour, 6 hours, and 24 hours following ejaculation. The serum PSA also was measured 48 hours and 1 week after ejaculation if the concentration had not returned to the baseline value by the previous time interval. All subjects abstained from ejaculation for a minimum of 7 days prior to the study and until the PSA concentration returned to the baseline level. Absolute and relative change in serum PSA concentration, as well as the time to return to baseline PSA concentration following ejaculation, were assessed. RESULTS: The serum PSA concentration increased following ejaculation in 87% of the subjects. The mean baseline PSA was 1.8 ng/mL (median, 0.7 ng/mL). The mean absolute PSA change +/- standard deviation 1 hour, 6 hours, 24 hours, and 48 hours after ejaculation was 0.8 +/- 1.32 ng/mL, 0.3 +/- 0.66 ng/mL, 0.2 +/- 0.33 ng/mL, and 0.4 +/- 0.40 ng/mL, respectively. The mean relative PSA change +/- standard error 1 hour, 6 hours, 24 hours, and 48 hours after ejaculation was 41 +/- 4%, 9 +/- 1.5%, 8 +/- 1.3%, and 10 +/- 2.3%, respectively. The absolute and relative changes in PSA concentration noted 1 hour, 6 hours, and 24 hours after ejaculation were statistically significant (P = 0.0001). A strong correlation was observed between absolute change in PSA and baseline serum PSA, at each time interval (1 hour: r = 0.68, 6 hours: r = 0.77, 24 hours: r = 0.70; P < 0.0001) after ejaculation. Similarly, a significant correlation was noted between absolute change in PSA and patient age at each time interval (1 hour: r = 0.37, 6 hours: r = 0.38; P = 0.002, 24 hours: r = 0.55; P < 0.0001). Ninety-two percent of subjects returned to baseline by 24 hours (95% confidence interval (Cl) = 83% to 97%), whereas 97% of subjects returned to baseline by 48 hours (95% Cl = 89% to 99%). CONCLUSIONS: Ejaculation causes a significant increase in the serum PSA concentration in men between 49 and 79 years of age that may persist for up to 48 hours. This change appears to correlate with age and baseline PSA. It is recommended that men abstain from ejaculation for 48 hours prior to having a serum PSA determination.

Age Factors↗
PubMed1996

Long-term follow-up of Graves ophthalmopathy in an incidence cohort.

PURPOSE: To provide long-term follow-up data on patients with Graves ophthalmopathy in an incidence cohort of 120 patients. METHODS: Data were obtained from a comprehensive review of each patient's community medical record, a follow-up survey, or both. RESULTS: The median interval between the initial ophthalmic examination and most recent follow-up was 9.8 years (range, 64 days to 17.4 years). Follow-up of more than 5 years was available for 96 patients (80.0 percent), whereas follow-up exceeding 10 years was achieved for 59 patients (49.2 percent). Persistent visual loss from optic neuropathy occurred in two eyes, with final visual acuities of 20/30 and 20/60, respectively. None of the patients reported deterioration of vision attributable to Graves ophthalmopathy in the interval since their last ophthalmic examination at the authors' institution. Two patients (2.2 percent) had constant diplopia, but it was correctable with spectacles (prisms) in each case. Nearly one third of respondents had had ocular discomfort during the preceding 4 weeks; the most frequent cause in 72 percent of patients was dry eyes. Among the respondents to the survey, 60.5 percent believed that the appearance of their eyes had not returned to what it had been before the development of thyroid disease, 51.6 percent thought that their eyes appeared abnormal, and 37.9 percent were dissatisfied with the appearance of their eyes. CONCLUSIONS: Although with treatment few patients have long-term functional impairment from Graves ophthalmopathy, more than one third of patients are dissatisfied with their ultimate appearance. The psychologic, aesthetic, economic, and social sequelae of the disorder require further definition by formal outcomes studies.

Adolescent↗
PubMed1996

The evolutionary distribution and structural organization of the homeobox-containing repeat D4Z4 indicates a functional role for the ancestral copy in the FSHD region.

Facioscapulohumeral muscular dystrophy (FSHD) is an autosomal dominant neuromuscular disease that has been linked to deletions within a tandem array of 3.2 kb repeats adjacent to the telomere of 4q. These repeats are also present in other locations in the human genome, including the short arms of all the acrocentric chromosomes. Here, we examine two models for the role of this repeat in FSHD. First, because of the extensive similarity between the 3.2 kb repeats on 4q and those adjacent to rDNA on the acrocentric chromosomes, we investigated whether the FSHD region on 4q is involved in sub-nuclear localization, specifically to the nucleolus. The results likely exclude any involvement of nucleolar localization in the development of FSHD. Second, we investigated a model that suggests that a functional gene may be buried within the tandem array of 3.2 kb repeats. Toward this end, we evaluated the evolutionary conservation of the repeat and a double homeodomain sequence within the repeat in a variety of primate species. The genomic organization of the 3.2 kb repeat in humans, great apes and lower primates identified the FSHD-associated repeat on chromosome 4q as the likely ancestral copy. The sequence of the rhesus monkey double homeodomain reveals significant sequence identity with the human 4q sequence. These results strongly suggest a functional role for a component of the FSHD-associated repeat.

Amino Acid Sequence↗
PubMed1996

Secondary failure rates of measles vaccines: a metaanalysis of published studies.

BACKGROUND: Recent measles outbreaks in highly vaccinated populations have highlighted the role of vaccine failure as a barrier to the elimination of measles. We sought to estimate the rate of secondary failure (clinical measles after vaccine-induced seroconversion) of measles vaccines using metaanalysis. METHODS: We identified 1411 studies of which 125 were relevant. From these we found 10 original studies of healthy subjects with sufficient details to calculate a pooled secondary failure rate. We performed a test for homogeneity before any pooling. RESULTS: Although significant heterogeneity prevented their pooling as a single group, the studies fell into three homogeneous groups suitable for pooling. Group A studies used killed vaccine whereas the other two groups (Groups B and C) of studies used live vaccine. These latter groups differ in that the studies in Group B share higher failure rates and are difficult to interpret with respect to the lack of verification of vaccination, immunization before 12 months of age and a non-North American study site and vaccine manufacturer. Those studies in Group C, in which US subjects were older than 12 months at vaccination and received a live US-manufactured vaccine that was documented in a medical record, had a failure rate of 0 of 2031 with a 95% confidence interval of 0.0 to 0.147%. CONCLUSIONS: Although reports of measles related to secondary failure exist, studies that permit the calculation of the rate of secondary failure demonstrate that the rate appears to be < 0.2%.

Child, Preschool↗
PubMed1996

Is school vision screening effective?

A population-based cohort of all children entering kindergarten in a three-year period (N = 2,938) was followed retrospectively from kindergarten through 12th grade to estimate incidence of abnormal school vision screening tests and rates of follow-up by community ophthalmologists or optometrists. Overall 28% of children had at least one abnormal school vision screening test. Abnormal screening with referral increased from 1.2% of five-year-olds to 9.1% of 13-year-olds. Overall, 91% of children referred had further evaluation by eye care professionals. However, visits to an eye care professional often were delayed; median time was 0.8 years for children seeing an ophthalmologist and 1.8 years for children seeing an optometrist. Results support the continued use of simple visual acuity screening in schools. Consideration should be given to screening children beyond age 12 and developing methods to increase the rapidity of parental response to referral recommendations.

Adolescent↗
PubMed1996

International comparison of the community prevalence of symptoms of prostatism in four countries.

We conducted an international comparison of the prevalence of urinary symptoms of prostatism in 4 countries, using a community-based random sampling of subjects, similar study procedures, and a single definition of cases that was based on a standardized symptom questionnaire. In Scotland 1,994 medically eligible men aged 40-79 years agreed to participate from 3 communities of the Forth Valley. In France, a nation-wide survey was conducted cross-sectionally in a representative sample of 2,011 French men aged 50-84 years. In the USA, the Olmsted County (OC) study recruited an age- and urban/rural-stratified random sample of 2,115 county residents drawn from medically eligible men aged 40-79 years. In Japan, 290 men aged 40-79 years from a fishing village participated in the study. Response rates were 55, 53, 55, and 43% in Scotland, France, OC and Japan, respectively. Urinary symptoms were assessed by the International Prostate Symptom Score (I-PSS), after metrologic validation in English and cross-cultural adaptation of the questionnaire. The prevalence of moderate to severe symptoms (I-PSS > 7) were 14, 18, 38, and 56% in France, Scotland, OC and Japan, respectively. This pattern was consistent within decades of age, and was found for most of the individual urinary symptoms. The proportion of men in Japan reporting very low I-PSS (0 or 1) was approximately 2, 4 and 8 times less frequent, than in OC, Scotland, and France, respectively. Differences in the prevalence of reported urinary symptoms might reflect between-country differences in the true prevalence of benign prostatic hyperplasia. However, cross-cultural differences in the perception and/or willingness to report urinary symptoms may play an important role in the observed differences. Further study will be required to elucidate the underlying causes of the observed differences.

Adult↗
PubMed1996

Epiglottitis in adults and children in Olmsted County, Minnesota, 1976 through 1990.

OBJECTIVE: To compare the initial clinical manifestations and sequelae of epiglottitis among children and adult residents of Olmsted County, Minnesota. MATERIAL AND METHODS: We conducted a population-based retrospective cohort study of all Olmsted County residents with the diagnosis of epiglottitis during the 15-year period from Jan. 1, 1976, through Dec. 31, 1990. RESULTS: From 1976 through 1990, 41 residents (20 children and 21 adults) of Olmsted County were diagnosed with epiglottitis. (One case in an adult was first diagnosed at autopsy and was included only in the incidence rates and analysis of seasonal and secular trends.) Children had a mean annual incidence rate of 4.25 per 100,000, whereas the rate in adults was 2.18 per 100,000. The age- and sex-adjusted incidence of epiglottitis decreased during the study period from 4.94 per 100,000 during 1976 through 1980 to 2.08 per 100,000 during 1986 through 1990. No seasonal effect was detected in adults or children. At initial assessment, adults tended to have pharyngeal symptoms (sore throat and odynophagia), cervical adenopathy, and ear pain, whereas children most often had respiratory (stridor, dyspnea, and retractions) and laryngeal symptoms. Proportionately, more children than adults received artificial airway support and had associated pneumonia. One death occurred in an adult, in whom the diagnosis was made at autopsy. CONCLUSION: The incidence of epiglottitis has decreased significantly in recent years. Children and adults have considerably different initial manifestations of epiglottitis.

Adolescent↗
PubMed1996

Japanese men have smaller prostate volumes but comparable urinary flow rates relative to American men: results of community based studies in 2 countries.

PURPOSE: We compared prostate volume and peak urinary flow rate in Japanese and American men 40 to 79 years old. MATERIALS AND METHODS: Prostate volume and peak urinary flow rate were measured in eligible Japanese men and results were compared to those of a randomly selected American cohort. RESULTS: Mean prostate volume plus or minus standard deviation averaged 20.3 +/- 10.6 ml. in Japanese and 29.6 +/- 13.4 ml. in American men, while predicted cross-sectional increases with age decade were 1.5 and 5.5 ml., respectively. Peak urinary flow rate was higher but the decrease with increasing age was greater in Japanese men. CONCLUSIONS: Prostate volume is larger and the increase with age is more pronounced in American than in Japanese men. However, Japanese men may have a higher peak urinary flow rate and greater cross-sectional decrease with age.

Adult↗
PubMed1996

Mental retardation in a birth cohort, 1976-1980, Rochester, Minnesota.

The cumulative incidence of mental retardation in a birth cohort of children born from 1976 through 1980 in Rochester, Minnesota (n = 5,919) was estimated. Rochester is the site of the Rochester Epidemiology Project, which captures virtually all medical care delivered locally. Passive follow-up through school and community medical records for criteria diagnostic of mild or severe mental retardation was undertaken. Thirty children were classified with mental retardation. The cumulative incidence of mental retardation by age 8 years was 9.1 per 1,000 (95% confidence interval = 6.2, 13.0) and was similar for boys and girls (8.3 vs. 10.0 per 1,000, respectively). The cumulative incidence for severe mental retardation in girls was more than twice that in boys; for mild retardation it was the opposite. The cumulative incidence among boys was 1.7 times greater than the cumulative incidence for girls. Results suggest that although the overall incidence of mental retardation by gender was similar, the severity may differ somewhat.

Child↗
PubMed1995

Incidence of prostate cancer diagnosis in the eras before and after serum prostate-specific antigen testing.

OBJECTIVE: To estimate the incidence of prostate cancer in Olmsted County, Minnesota, from 1983 through 1992 to describe the secular changes that have occurred since the introduction of serum prostate-specific antigen (PSA) testing to the community medical practice in 1987. DESIGN: Population-based, descriptive epidemiological study with ecological and individual level comparisons over time. STUDY SETTING: Olmsted County, Minnesota, where the Rochester Epidemiology Project provides passive surveillance of the population for health outcomes. SUBJECTS: All 511 biopsy-proven incident cases of adenocarcinoma of the prostate diagnosed from 1983 through 1992. The community inpatient and outpatient medical records of all incident cases were reviewed to evaluate the presenting characteristics of men at the time of diagnosis. RESULTS: The age-adjusted incidence of biopsy-proven prostate cancer increased from 64 per 100,000 person-years in 1983 to 216 per 100,000 person-years in 1992. The increase occurred primarily between 1987 and 1988 and was predominately for organ-confined tumors. The age-specific incidence increased dramatically in this same period among men aged 50 years and older. Among men aged 70 years and older, however, prostate carcinoma incidence rates declined after 1990 following the initial increase. This decline among older men contrasted with community-based estimates of PSA utilization rates, which demonstrated consistent increases since 1987 to nearly 50% of the older population in 1992. CONCLUSION: These results support the premise that the recent increase in prostate cancer is due in part to the increased utilization of serum PSA testing. Further, the increased incidence appears to be a transient phenomenon due to the depletion of previously undiagnosed cases from the previous pool. Finally, these data suggest that, in terms of stage at diagnosis, early detection efforts may be effective in identifying more early stage (smaller) cancers.

Adenocarcinoma↗
PubMed1995

Association between family history of benign prostatic hyperplasia and urinary symptoms: results of a population-based study.

Baseline measurements for a population-based prospective cohort study were used to assess the association between family history of enlarged prostate and urinary symptoms. Between December 1989 and March 1991, a group of randomly selected men aged 40-79 years from Olmsted County, Minnesota, was administered a previously validated questionnaire that included questions with wording close to that of the American Urological Association's Symptom Index. A detailed family history of an enlarged prostate was obtained by personal interview, and peak urinary flow rates were measured for each participant. Of the 2,119 men, 440 (21 percent) reported a family history of an enlarged prostate. The age-adjusted odds of having moderate or severe urinary symptoms were elevated among those with a family history relative to those without (odds ratio = 1.3, 95 percent confidence interval 1.1-1.7). With simultaneous control for effects of age and worry about urologic function, the odds ratio remained at 1.3 (95 percent confidence interval 1.0-1.6). Furthermore, this risk was greater for men with relatives diagnosed at a younger age (odds ratio = 2.5, 95 percent confidence interval 1.5-4.3). Men with a family history were also 1.3 times as likely to have an impaired peak urinary flow rate. These findings suggest that men with a family history of an enlarged prostate may be at increased risk for development of symptoms and signs suggestive of benign prostatic hyperplasia and that this risk is greater in men with relatives diagnosed at a younger age. Recognition of this association may help to target early interventions and may lead to further clues about the causes of benign prostatic hyperplasia.

Adult↗
PubMed1995

New diagnostic and treatment guidelines for benign prostatic hyperplasia. Potential impact in the United States.

BACKGROUND: The Agency for Health Care Policy and Research (AHCPR) recently released the clinical practice guidelines for the diagnosis and treatment of benign prostatic hyperplasia. Prevalence estimates from a population-based cross-sectional study, the baseline component of a cohort study of the natural history of prostatism, were used to assess their potential impact in the United States. METHODS: The study group comprised a population-based sample of white men aged 50 to 79 years who were randomly selected within age- and residence-specific strata from the Olmsted County, Minnesota, population (1990 census, 105,720). These 1317 men completed symptom assessments and diagnostic evaluations that paralleled the AHCPR guidelines, including the measurement of urinary flow rates and, for a subset (n = 303), ultrasonic determination of postvoiding residual urine volume. RESULTS: The application of the AHCPR benign prostatic hyperplasia diagnostic guidelines to the study cohort (American Urologic Association Symptom Index > 7 and peak urinary flow rate < 15 mL/s) suggests that 17% of men aged 50 to 59 years, 27% of men aged 60 to 69 years, and 35% of men aged 70 to 9 years are eligible to discuss treatment options. Application of these percentages to the 1990 US white population suggests that approximately 5.6 million men aged 50 to 79 years are eligible to discuss treatment options. This number will double by the year 2020 owing to the aging of the population. CONCLUSION: The projected number of men potentially meeting AHCPR guidelines to discuss treatment options for benign prostatic hyperplasia could have a substantial impact on the health care system; this will be compounded by the aging of the population.

Adult↗
PubMed1995

Population-based study of the contribution of weather to hip fracture seasonality.

Previous studies have demonstrated seasonal increases in hip fracture incidence, but none have directly assessed the influence of inclement weather on this seasonality. In this study, the daily occurrence of hip fracture among women aged 45 years and older in Rochester, Minnesota, from 1952 through 1989 was ascertained using the resources of the Rochester Epidemiology Project and compared with the occurrence of inclement weather as recorded in hourly readings by the National Weather Service in Rochester for the same time period. Among the women aged 45-74 years, the risk of hip fracture was increased on days with snow (relative risk (RR) = 1.41, 95% confidence interval (CI) 1.10-1.81) or freezing rain (RR = 1.82, 95% CI 1.27-2.62). In this group, the elevated risk of hip fracture in winter, compared with summer (RR = 1.44, 95% CI 1.0-2.09), was reduced after controlling for weather (RR = 1.16, 95% CI 0.81-1.65). Among women aged 75 years and older, ice and snow were not strongly related to fracture occurrence. The winter-related increase in risk (RR = 1.16, 95% CI 0.96-1.40) was essentially unchanged after controlling for weather and was similar to the weather-adjusted seasonality of hip fracture occurrence in younger women. These data suggest that there are factors other than weather that may be linked to the seasonal pattern in hip fracture occurrence and that operate at all ages.

Aged↗
PubMed1995

The incidence of Graves' ophthalmopathy in Olmsted County, Minnesota.

PURPOSE: To determine the incidence of Graves' ophthalmopathy. METHODS: A population-based cohort of all Olmsted County, Minnesota, residents who had ophthalmopathy associated with autoimmune thyroid disease between Jan. 1, 1976, and Dec. 31, 1990, was identified through the medical diagnostic index of the Mayo Clinic and the Rochester Epidemiology Project. RESULTS: One hundred twenty incident patients were identified, of whom 103 (85.8%) were women (P = .00001; normal relative deviate test). The overall age-adjusted incidence rate for women was 16.0 cases per 100,000 population per year, whereas the rate for men was 2.9 cases per 100,000 population per year (standardized rate ratio, 5.5; 95% confidence interval, 3.3 to 9.3). The distribution of incidence rates by five-year age groups included peak incidence rates in the age groups 40 to 44 years and 60 to 64 years in women, and 45 to 49 years and 65 to 69 years in men. CONCLUSIONS: Incidence rates for Graves' ophthalmopathy exhibited an apparent bimodal peak for both men and women, although the peaks for men occurred approximately five years after those for women. No explanation for these trends was apparent from the data collected.

Adolescent↗
PubMed1995

Free, complexed and total serum prostate specific antigen: the establishment of appropriate reference ranges for their concentrations and ratios.

PURPOSE: Prostate specific antigen (PSA) exists in the serum in several molecular forms that can be measured by immunodetectable assays: free PSA, PSA complexed to alpha 1-antichymotrypsin (complexed PSA) and total PSA, which represents the sum of the free and complexed forms. We determined the normal distribution of values and established the appropriate reference ranges for these 3 molecular forms of PSA and their ratios (free-to-total, complexed-to-total and free-to-complexed PSA). Knowing the amount and ratio of these molecular forms appears to be useful in enhancing the ability of PSA to distinguish potentially curable prostate cancer from benign prostatic hyperplasia and in decreasing the number of unnecessary prostate biopsies. MATERIALS AND METHODS: A total of 422 healthy men 40 to 79 years old was randomly chosen from the male population of Olmsted County, Minnesota and underwent a detailed clinical examination that included digital rectal examination, serum PSA determination and transrectal ultrasound to exclude the presence of prostate cancer. Using newly developed, monoclonal-monoclonal immunofluorometric assays for each molecular form, the free, complexed and total PSA, and the ratios of these 3 forms were determined for each study participant. RESULTS: All 3 molecular forms correlated directly with patient age (r = 0.45, r = 0.43 and r = 0.45, respectively). Using the 95th percentile, the recommended age-specific reference ranges for the free, complexed and total PSA forms, respectively, are 0.5, 1.0 and 2.0 ng./ml. for men 40 to 49 years old; 0.7, 1.5 and 3.0 ng./ml. for men 50 to 59 years old; 1.0, 2.0 and 4.0 ng./ml. for men 60 to 69 years old, and 1.2, 3.0 and 5.5 ng./ml. for men 70 to 79 years old. With regard to each of the ratios (free-to-total, complexed-to-total and free-to-complexed PSA) none correlated with patient age. As a result, the appropriate upper limit of normal (95th percentile) for all 3 ratios is constant for men of all ages. These reference ranges are greater than 0.15 for free-to-total PSA ratio, less than 0.70 for complexed-to-total PSA ratio and greater than 0.25 for free-to-complexed PSA ratio. The free-to-total PSA ratio will have its greatest value for men with a serum PSA value between 2 and 10 ng./ml. CONCLUSIONS: The establishment of appropriate reference ranges for free, complexed and total PSA as well as the ratios will allow the practicing urologist to incorporate these new parameters into the diagnostic evaluation of men at risk for early, potentially curable prostate cancer.

Adult↗