Search PubMed⌕ Search

Biomedical subjects

J B McKinlay

Publications and source records attributed to J B McKinlay.

At least 19 recordsLinked to original sources
PubMed2004

Prevalence of foot and ankle conditions in a multiethnic community sample of older adults.

The prevalence of foot and ankle disorders was determined in a community-based, multiethnic (non-Hispanic White, African American, and Puerto Rican) random sample of 784 community-dwelling adults aged 65 or more years in 2001-2002 in Springfield, Massachusetts. Overall, the five most common conditions were toenail disorders (74.9%), lesser toe deformities (60.0%), corns and calluses (58.2%), bunions (37.1%), and signs of fungal infection, cracks/fissures, or maceration between toes (36.3%); 30.9% had some tenderness to palpation of the foot or ankle, and 14.9% had ankle joint pain on most days in the past 4 weeks. Toenail conditions, fungal symptoms, and ulcers or lacerations were more common in men, while bunions and corns and calluses were more common in women (p < 0.001). Significant racial/ethnic differences, independent of education or gender, were found for the prevalence of most toe deformities and flat feet, as well as for corns and calluses, fungal signs, edema, ankle joint pain, tenderness to palpation, and sensory loss. Foot and ankle disorders are common in these older adults. Examination of their prevalence in different segments of the community may inform future studies to determine etiology and means of prevention.

Aged↗
PubMed2001

Testosterone level, androgen receptor polymorphism, and depressive symptoms in middle-aged men.

BACKGROUND: Testosterone (T) level declines progressively with age. Psychiatric symptoms of T deficiency (e.g., dysphoria, fatigue, irritability, low libido) are also symptoms of depression, and appear to be variably expressed. METHODS: We assessed independent measures of hypothalamic-pituitary-gonadal axis functioning, i.e., total T level and androgen receptor (AR) CAG repeat length (CAG RL), a genetic trait marker associated with AR function; and depression (diagnosed by above-threshold score on the Center for Epidemiologic Studies-Depression Scale [CES-D]) in 1000 men (mean age = 62.6 years; SD = 8.3) who participated in the Massachusetts Male Aging Study. RESULTS: There were 110 (11%) men with "depression" (CES-D score > or = 16) in the analysis sample. Neither total T level nor CAG RL was associated with depression in bivariate analyses. Among men with shorter CAG RLs, the percentage of men with depression was 21.6% in the lowest subgroup of total T (defined by quintiles) and 4.2% in the highest subgroup of total T. This was confirmed in simple logistic regression models with depression as the dependent variable and continuous total T as the predictor, run separately within the three CAG RL subgroups: depression was significantly and inversely associated with total T in men with shorter CAG RLs but not in men with moderate and longer CAG RLs. CONCLUSIONS: CAG isotype, a genetic trait marker of androgen receptor function, may mediate the expression of the central nervous system effects of T deficiency in men.

Aged↗
PubMed2001

Low dehydroepiandrosterone and ischemic heart disease in middle-aged men: prospective results from the Massachusetts Male Aging Study.

The adrenal steroid dehydroepiandrosterone (DHEA) and its sulfate (DHEAS) have been characterized as "protective" against ischemic heart disease (IHD), especially in men, on the basis of sparse epidemiologic evidence. The authors used data from the Massachusetts Male Aging Study, a random sample prospective study of 1,709 men aged 40-70 years at baseline, to test whether serum levels of DHEA or DHEAS could predict incident IHD over a 9-year interval. At baseline (1987-1989) and follow-up (1995-1997), an interviewer-phlebotomist visited each subject in his home to obtain comprehensive health information, body measurements, and blood samples for hormone and lipid analysis. Incident IHD between baseline and follow-up was ascertained from hospital records and death registries, supplemented by self-report and evidence of medication. In the analysis sample of 1,167 men, those with serum DHEAS in the lowest quartile at baseline (<1.6 microg/ml) were significantly more likely to incur IHD by follow-up (adjusted odds ratio = 1.60, 95 percent confidence interval: 1.07, 2.39; p = 0.02), independently of a comprehensive set of known risk factors including age, obesity, diabetes, hypertension, smoking, serum lipids, alcohol intake, and physical activity. Low serum DHEA was similarly predictive. These results confirm prior evidence that low DHEA and DHEAS can predict IHD in men.

Adult↗
PubMed2001

Are serum hormones associated with the risk of prostate cancer? Prospective results from the Massachusetts Male Aging Study.

OBJECTIVES: To determine whether prediagnostic serum hormones are predictive of prostate cancer risk in a sample of men 40 to 70 years old at baseline. METHODS: Seventeen serum hormones, including androgens, estrogens, and adrenal and pituitary hormones, were measured at baseline (1987 to 1989) and used to predict incident prostate cancer by follow-up (1995 to 1997) using data from the Massachusetts Male Aging Study, a prospective, population-based random sample. RESULTS: Seventy men (4%) of 1576 were diagnosed with prostate cancer between the baseline and follow-up periods (approximately 8 years). None of the hormones were associated with prostate cancer risk except for androstanediol glucuronide (AAG), which exhibited a nonlinear, inverse relationship with prostate cancer (P <0.003) when age, body mass index, alcohol use, dihydrotestosterone, and total prostate-specific antigen were controlled for. Men in the second, third, and fourth quartiles of AAG relative to the first were less likely to be diagnosed with prostate cancer, although only the comparison of the second versus the first achieved statistical significance (odds ratio 0.2, 99% confidence interval 0.04 to 0.6). No dose-response relationships were observed. CONCLUSIONS: The lack of association with most hormones and the nonlinear association with AAG calls into question whether serum hormones collected during midlife are risk factors for prostate cancer.

Adrenal Cortex Hormones↗
PubMed2001

Risk factors for clinical benign prostatic hyperplasia in a community-based population of healthy aging men.

We defined risk factors for a clinical diagnosis of benign prostatic hyperplasia (BPH) among subjects of the population-based Massachusetts Male Aging Study. In 1987-89 1709 men aged 40-70 provided baseline risk factor data and were followed for a mean of 9 years; 1019 men without prostate cancer provided follow-up data. We classified men with clinical BPH at follow-up if they reported (1) frequent or difficulty urinating and were told by a health professional that they had an enlarged or swollen prostate or (2) if they reported having surgery for BPH. At follow-up the prevalence of clinical BPH was 19.4%, increasing from 8.4% of men aged 38-49 years to 33.5% of men aged 60-70 years (P < 0.001 for trend). Elevated free PSA levels (age- and total PSA-adjusted OR, top vs. bottom quartile ng/mL 4.4, 95% CI 1.9-10.5), heart disease (age-adjusted OR 2.1, CI 1.3-3.3), and use of beta-blocker medications (OR 1.8, CI 1.1-3.0) increased odds for BPH, while current cigarette smoking (OR 0.5, CI 0.3-0.8) and high levels of physical activity (top vs. bottom quartile kcals/day OR 0.5, CI 0.3-0.9) decreased odds of BPH. All but the medication effects persisted in fully adjusted multivariable models. Total or fat calorie intake, sexual activity level, alcohol intake, body mass index, waist-hip ratio, diastolic blood pressure, a history of diabetes, hypertension, vasectomy, or serum levels of androgens or estrogens did not individually predict clinical BPH. We conclude that physical exercise and cigarette smoking appear to protect against development of clinical BPH. Elevated free PSA levels predict clinical BPH independent of total PSA levels. Risk associated with heart disease does not appear to be due solely to detection bias or to effects of heart disease medications. A wide variety of other characteristics appear to have no influence on risk for clinical BPH.

Adult↗
PubMed2001

Drug therapy and prevalence of erectile dysfunction in the Massachusetts Male Aging Study cohort.

STUDY OBJECTIVE: To examine the association of commonly used drugs with erectile dysfunction (ED) at two time points. DESIGN: Population-based, cross-sectional, survey analysis. PARTICIPANTS: Randomly selected cohort of men in the Massachusetts Male Aging Study (MMAS) that included 1476 men for the baseline (1987-1989) and 922 for the follow-up (1995-1997) analyses. INTERVENTION: Crude associations between specific drug categories were examined with chi2 statistics. Logistic regression analysis was used to separate the effect of drugs from the influence of heart disease, hypertension, untreated diabetes, or depressive symptoms. MEASUREMENTS AND MAIN RESULTS: In the MMAS, medical history, current drug use, and erectile function status were ascertained with in-home interviews. In unadjusted analyses, thiazide and nonthiazide diuretics, beta-blockers, calcium channel blockers, angiotensin-converting enzyme inhibitors, benzodiazepines, digitalis, nitrates, 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors, and histamine2 receptor antagonists were associated with prevalent ED. Adjustment for comorbidities and health behaviors attenuated these associations, with only nonthiazide diuretics and benzodiazepines remaining statistically significant. CONCLUSION: Several common drugs may increase prevalence of ED; however, additional data from larger populations are needed to determine whether these associations are independent of underlying health conditions and to explore the effects of dosage and duration of use.

Adult↗
PubMed2000

Family history and the risk of prostate cancer.

OBJECTIVES: Several studies have identified prostate cancer family history as a risk factor for prostate cancer incidence, typically associated with a twofold to fourfold increase in risk. A family history of breast cancer has also been implicated. We investigated the associations between prostate cancer incidence and family histories of prostate and breast cancer, controlling for possible confounding due to environmental factors. METHODS: Data from the random sample-based Massachusetts Male Aging Study cohort (1987 to 1997) were used. Incidence rates were calculated as the number of cases per person-year of follow-up. Covariates were adjusted for using Poisson regression. RESULTS: Among 1149 men with an average of 8.7 person-years of follow-up, 57 were diagnosed with prostate cancer, 110 men reported a prostate cancer family history, and 157 reported a breast cancer family history. The age-adjusted relative risk (RR) of prostate cancer incidence associated with prostate cancer family history was 3.29 (95% confidence interval [CI] 1.82 to 5.94). No evidence of heterogeneity was found across age levels (P = 0.83). Additional adjusting for environmental factors such as smoking, alcohol use, body mass index, physical activity, education, sexually transmitted disease history, diet, and hormone levels yielded a slightly higher RR (3.78, 95% CI 1.96 to 7.28). No association with a family history of breast cancer was evident (RR = 1.18, 95% CI 0.51 to 2.43). CONCLUSIONS: We found an association between prostate cancer incidence and a family history of prostate cancer, independent of environmental factors. No association with a family history of breast cancer was evident.

Aged↗
PubMed2000

Relation between psychosocial risk factors and incident erectile dysfunction: prospective results from the Massachusetts Male Aging Study.

Erectile dysfunction (ED) is recognized as a major public health problem. ED may be due to a wide range of factors, but recent work has focused on the medical and physical etiology of ED. The importance of psychosocial risk factors should not be dismissed, however, and several cross-sectional studies have reported associations between ED and depression, anger, and dominance. Whether these factors are prospectively associated with the risk of ED has yet to be established. Longitudinal data obtained from 776 respondents in the Massachusetts Male Aging Study (1987-1997) were used to examine whether the presence of depressive symptoms, the way in which anger was expressed, or the trait of dominance independently contributed to the risk of ED 8.8 years later. The results suggest that new cases of ED are much more likely to occur among men who exhibit a submissive personality. The implications of these findings are discussed.

Adult↗
PubMed2000

Modifiable risk factors and erectile dysfunction: can lifestyle changes modify risk?

OBJECTIVES: To prospectively examine whether changes in smoking, heavy alcohol consumption, sedentary lifestyle, and obesity are associated with the risk of erectile dysfunction. METHODS: Data were collected as part of a cohort study of a random sample of men 40 to 70 years old, selected from street listings in the Boston Metropolitan Area, Massachusetts. In-home interviews were completed by 1709 men at baseline in 1987 to 1989 and 1156 men at follow-up in 1995 to 1997 (average follow-up 8.8 years). Analyses included 593 men without erectile dysfunction at baseline, who were free of prostate cancer, and had not been treated for heart disease or diabetes. The incidence of moderate to complete erectile dysfunction was determined by discriminant analysis of responses to a self-administered sexual function questionnaire. RESULTS: Obesity status was associated with erectile dysfunction (P = 0.006), with baseline obesity predicting a higher risk regardless of follow-up weight loss. Physical activity status was associated with erectile dysfunction (P = 0.01), with the highest risk among men who remained sedentary and the lowest among those who remained active or initiated physical activity. Changes in smoking and alcohol consumption were not associated with the incidence of erectile dysfunction (P >0.3). CONCLUSIONS: Midlife changes may be too late to reverse the effects of smoking, obesity, and alcohol consumption on erectile dysfunction. In contrast, physical activity may reduce the risk of erectile dysfunction even if initiated in midlife. Early adoption of healthy lifestyles may be the best approach to reducing the burden of erectile dysfunction on the health and well-being of older men.

Adult↗
PubMed2000

Erectile dysfunction and coronary risk factors: prospective results from the Massachusetts male aging study.

BACKGROUND: Erectile dysfunction (ED), a wide spread and troublesome condition among middle-aged men, is partly vascular in origin. In the Massachusetts Male Aging Study, a random-sample cohort study, we investigated the relationship between baseline risk factors for coronary heart disease and subsequent ED, on the premise that subclinical arterial insufficiency might be manifested as ED. METHODS: Men ages 40-70, selected from state census lists, were interviewed in 1987-1989 and reinterviewed in 1995-1997. Data were collected and blood was drawn in participants' homes. ED was assessed from responses to a privately self-administered questionnaire. Analysis was restricted to 513 men with no ED at baseline and no diabetes, heart disease, or related medications at either time. RESULTS: Cigarette smoking at baseline almost doubled the likelihood of moderate or complete ED at followup (24% vs. 14%, adjusted for age and covariates, P = 0.01). Cigar smoking and passive exposure to cigarette smoke also significantly predicted incident ED, as did overweight (body-mass index > or =28 kg/m(2)) and a composite coronary risk score. Weaker prospective associations were seen for hypertension and dietary intake of cholesterol and unsaturated fat. CONCLUSIONS: Erectile dysfunction and coronary heart disease share some behaviorally modifiable determinants in men who, like our sample, are free of manifest ED or predisposing illness. Open questions include whether modification of coronary risk factors can prevent ED and whether ED may serve as a sentinel event for coronary disease.

Adult↗
PubMed2000

Socioeconomic factors and incidence of erectile dysfunction: findings of the longitudinal Massachussetts Male Aging Study.

Despite the well-documented relationship of socioeconomic factors (SEF) to various health problems, the relationship of SEF to erectile dysfunction (ED) is not well understood. As such, the goals of this paper are: (1) to determine whether incident ED is more likely to occur among men with low SEF; and (2) to determine whether incident ED varies by SEF after taking into consideration other well-established ED risk factors that are also associated with SEF such as smoking, diabetes, and high blood pressure. We used data from 797 participants in the longitudinal population-based Massachusetts Male Aging Study (baseline 1987-1989, follow-up 1995-1997) who were free of ED at baseline and had complete data on ED and all risk factors. ED was determined by a self-administered questionnaire and its relationship to SEF was assessed using logistic regression. We first analyzed the age-adjusted relationship of education, income, and occupation to incidence of ED. The results show that men with low education (O.R. = 1.46, 95% C.I. = 1.02-2.08) or men in blue-collar occupations (O.R. = 1.68, 95% C.I. = 1.16-2.43) are significantly more likely to develop ED. For the multivariate model, due to multicollinearity among education, income, and occupation, we ran three separate models. After taking into consideration all the other risk factors--age, lifestyle and medical conditions--the effect of occupation remained significant. Men who worked in blue-collar occupations were one and a half times more likely to develop ED compared to men in white-collar occupations (O.R. = 1.55, 95% C.I. = 1.06-2.28).

Aged↗
PubMed2000

A new surrogate variable for erectile dysfunction status in the Massachusetts male aging study.

Erectile dysfunction (ED) is the subject of a vast clinical literature, but little information has been gathered from random samples of the general public. The Massachusetts Male Aging Study (MMAS) addressed this important aspect of men's health. The MMAS was conducted in two waves, with baseline data collection in 1987-1989 and follow-up in 1995-1997. Subsequent to the baseline MMAS survey, a consensus developed that subjective measures are optimal for defining ED. Unfortunately, the baseline questionnaire did not ask subjects directly about their erectile functioning. Thus, we previously assigned the MMAS subjects a degree of impotence at baseline using a series of related questions, employing a discriminant formula constructed from a separate sample of urology clinic patients. At follow-up the men classified themselves directly in addition to answering the original series of related questions. In the present article, we report the results of a new discriminant function, based on the MMAS men at follow-up. We also compare the two methods and discuss our reasons for preferring the internally calibrated method.

Cross-Sectional Studies↗
PubMed2000

Measurement of erectile dysfunction in population-based studies: the use of a single question self-assessment in the Massachusetts Male Aging Study.

A concise, reliable means of assessing erectile dysfunction (ED) in large, multidisciplinary population-based studies is needed. A single, direct question for self-assessed ED was assessed in the population-based sample of the Massachusetts Male Aging Study (MMAS). Of the 1156 respondents to the 1995-97 MMAS follow-up evaluation, 505 were randomly selected to complete either the International Index of Erectile Function (IIEF) (n = 254), or the Brief Male Sexual Function Inventory (BMSFI) (n = 251), in addition to the single question self-assessment. The proportion not classified due to missing data was MMAS-9%, BMSFI-8%, and IIEF-18%. The single question correlated well with these other measures (r = 0.71-0.78, P < 0.001). Prevalence was similar to that based on the IIEF, agreement was moderate (kappa = 0.56-0.58), and associations with previously identified risk factors were similar for each classification. Thus, the MMAS single question may be a practical tool for population-based studies where detailed clinical measures of ED are impractical.

Adult↗
PubMed2000

The worldwide prevalence and epidemiology of erectile dysfunction.

This paper: (i) describes the worldwide prevalence of erectile dysfunction (ED); (ii) presents age-specific incidence rates for ED in the US; (iii) summarizes some key epidemiologic correlates of ED in the general population; and (iv) considers the possibility that ED may be a biobehavioral marker (sentinel event) of subsequent cardiovascular disease in men. Clinical, anthropometric, life style and hormonal data are presented from the milestone Massachusetts Male Aging Study (MMAS), a large (over 1000) prospective cohort of randomly sampled community-dwelling, normally aging men. Newly updated population prevalence and (more importantly) age-specific incidence rates are reported. We also estimate the likely magnitude of ED that will accompany the worldwide globalization of aging. Key correlates (predictors) of incident ED, especially vasculogenic influences, are identified and discussed. In conclusion, ED is a common biobehavioral phenomenon and there are strong physiological and epidemiological reasons for considering it a major marker (or predictor) of subsequent cardiovascular disease in men. International Journal of Impotence Research (2000) 12, Suppl 4, S6-S11.

Age Distribution↗
PubMed2000

Construction and field validation of a self-administered screener for testosterone deficiency (hypogonadism) in ageing men.

To design a self-administered screening questionnaire to inform men about their risk for testosterone deficiency. The screener was developed in two phases. First was a construction phase in which relevant risk factors and a scoring algorithm were defined from multiple logistic regression analyses of survey data. In the second phase, the screener's accuracy (based on sensitivity, specificity, and Receiver Operating Characteristic (ROC) curves) was tested using patients from a primary care clinic. All subjects provided blood samples for endocrine testing. Survey data from 1660 men aged 40-79 years participating in the Massachusetts Male Ageing Study (MMAS) were analysed in the first phase. The clinic sample consisted of 304 men aged 40-79 years presenting at a large Massachusetts primary health care clinic for routine check-ups or minor medical problems. The primary outcome was testosterone deficiency, defined as serum total testosterone below 12.1 nmol/l. Self-reported variables considered as potential risk factors included age, obesity, chronic diseases, health behaviour, the Jackson dominance scale, and symptoms of stress. The prevalence of testosterone deficiency was 20.4% in the MMAS and 42.1% in the clinic sample. An eight-item screener was developed based on age, body mass index, diabetes, asthma, headaches, sleep patterns, dominance preferences, and smoking status. The screener performed significantly better than chance in identifying men with low testosterone levels; the area under the ROC curve was 0.66 in the MMAS sample and 0.67 in the clinic sample. The self-scored screener developed in this study reliably detects men at risk of hypogonadism. The screener encourages at risk men to seek professional evaluation of their testosterone levels.

Adult↗
PubMed2000

Prostate cancer: how much do we know and how do we know it?

We use data from the Massachusetts Male Aging Study to approximate the total current knowledge about prostate cancer and to evaluate the relative contributions of various risk factors. The sum total of current knowledge is assessed using the area under the receiver operating characteristic curve (AUROC) and by the Hosmer-Lemeshow statistic in a logistic regression model that includes 30 risk factors identified in the literature that are available in the data set. Relative contributions are measured using the adjusted generalized R2 (AR2). To measure relative contributions, we group risk factors with similar etiology and then remove groups and compare the AR2 attained without each group to the AR2 with all variables included. The overall model fits adequately. The A UROC is 0.788, relatively far from its default value of 0.5, and the Hosmer-Lemeshow statistic has a p value of 0.926. We conclude that, while some knowledge about prostate cancer has been accumulated, there are still more risk factors yet unsuspected. The relative importance analysis shows that immutable factors (i.e. age, genotype) contribute 42%, dietary factors 30%, other lifestyle factors 15%, and endocrinological factors 11%. We recommend that age and other unchanging factors should be the primary focus of screening and risk evaluation and that future interventions should center on nutritional behavior.

Journal Article↗
PubMed2000

Diet and sex hormone-binding globulin.

The serum concentration of sex hormone-binding globulin (SHBG) is inversely related to weight and in animal studies is inversely related to protein intake. As SHBG can affect the biological activity of testosterone and estradiol, we wished to determine the role of protein intake on SHBG levels in men. Using data from the Massachusetts Male Aging Study we examined cross-sectional relationships between dietary components and SHBG levels in 1552 men (aged 40-70 yr) for whom these factors were known. Analyzed by multiple regression, controlling for testosterone and estradiol levels, age (P<0.001) and fiber intake (P = 0.02) were positively correlated to SHBG concentration, whereas body mass index (P<0.001) and protein intake (P<0.03) were negatively correlated to SHBG concentration. The intakes of calories, fat (animal or vegetable), and carbohydrate were not related to SHBG concentration. We conclude that age and body mass index are major determinants of SHBG concentrations in older men, and fiber and protein intake are also significant contributors to SHBG levels, but total caloric intake and the intake of carbohydrate or fat are not significant. Thus, diets low in protein in elderly men may lead to elevated SHBG levels and decreased testosterone bioactivity. The decrease in bioavailable testosterone can then result in declines in sexual function and muscle and red cell mass, and contribute to the loss of bone density.

Adult↗