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Biomedical subjects

J B McKinlay

Publications and source records attributed to J B McKinlay.

At least 73 records · Page 4Linked to original sources
PubMed1993

HIV risk among Latino adolescents in two New England cities.

OBJECTIVES: Latino adolescents in two urban New England areas were surveyed to assess risk of human immunodeficiency virus (HIV) transmission. METHODS: Probability of HIV infection during the previous 6 months was estimated from self-reported sexual contacts, condom usage rates, and number of partners. Teens were also asked to show condoms in their possession to the interviewer to validate self-reports of condom use. RESULTS: Overall, 8% of the 586 respondents were classified as high risk for HIV infection (estimated infection probability greater than .0001), 34% were at moderate risk, and the remaining 58% were classified as not at risk (no sexual activity or needle sharing). Teens who said they had purchased condoms or claimed to have used them recently were more likely than others to have condoms in their possession at the time of the interview. CONCLUSIONS: These estimates suggest that a small percentage of Latino adolescents may be at substantial risk for HIV infection over periods as short as 6 months, that self-reports of recent condom use are strongly related to condom possession, and that questionnaire items regarding condom use at last intercourse are poor surrogates for HIV risk.

Adolescent↗
PubMed1993

Do blacks and whites differ in reporting Rose Questionnaire angina? Results of the Boston Health Care Project.

We investigated the prevalence of angina (as determined by the Rose Questionnaire) in a random sample of African-American and white adults, aged 44 to 75 years, in three Boston (Mass) neighborhoods. Telephone interviews were completed by 2030 eligible subjects (response rate = 87.9%). A sample of 737 persons who had never been hospitalized for a heart attack also participated in a home visit. The prevalence of Rose angina was 7.0% in black women, 4.8% in white women, 5.0% in black men, and 5.7% in white men (P = .37). In both racial groups, respondents with diagnosed cardiovascular conditions, those taking cardiovascular medications, and those living alone were more likely to report angina than were other respondents. Blacks were more likely to report angina if they felt they were not getting needed medical care. Risk of angina declined with age among whites. In the home visit sample, the presence of major electrocardiogram abnormalities was also associated with angina. Rose angina appears to be influenced by similar risk factors in both blacks and whites.

Adult↗
PubMed1993

Is family care on the decline? A longitudinal investigation of the substitution of formal long-term care services for informal care.

The focus on rising costs of long-term care now encompasses community as well as institutional care. Policy makers cite the potential impact of changing social trends on informal caregivers' availability to continue as the main source of care and the possibility that formal services will then replace this informal care. They fear that families will relinquish their caregiving role if publicly funded home care services are available. Longitudinal data from a sample of disabled elders were used to investigate the substitution of formal services for informal care over a seven-year period. The substitution that was detected could be traced to the limited availability of informal care, and it represented a temporary change in the informal care pattern rather than a permanent replacement for it. Instead, use of formal services has supported the elderly person's continued residence in the community.

Aged↗
PubMed1992

Refusal rates in a longitudinal study of older people: implications for field methods.

Use of a carefully designed refusal conversion protocol at first follow-up in a longitudinal study of a representative sample of over 4,000 older people was investigated. Respondents who refused initially did not differ from respondents by age or gender but were more functionally independent, citing disinterest most frequently as the reason for refusal. The protocol was successful in convincing 43 percent of these initial refusals to continue participation, but less successful with proxy respondents (27% converted). Most of the refusals that were converted were done by telephone at minimal cost. Results show that it is possible, given appropriate field methods, to retain the very old and disabled in longitudinal studies.

Aged↗
PubMed1992

Response comparability of family and staff proxies for nursing home residents.

Response comparability on a wide variety of factual and judgmental information regarding nursing home residents was assessed for two proxy groups: family and staff. Family proxies had the most information. Family and staff proxies are not interchangeable. A general lack of response comparability suggests that proxies for nursing home residents should be selected in relation to the type of data needed and the time period of interest.

Activities of Daily Living↗
PubMed1992

Health survey methods with minority populations: some lessons from recent experience.

Until recently, minority populations have been inadequately or inaccurately represented in health research. Researchers are now recognizing the need to improve the validity and reliability of data on the health status and health-related behaviors of minorities. This paper discusses important methodological issues in conducting health survey research in minority communities: construction of an appropriate sampling frame, response rates, attrition from panel studies, and response patterns. These themes are illustrated with data from three field studies at the New England Research Institute. Two of these studies focus on inner-city Puerto Rican youth, a group rapidly increasing in size. The extent and multiplicity of problems experienced by this group affect the complexity of survey protocols. The third study is a random-digit-dial telephone survey on health care utilization for coronary heart disease by black and white adults from three inner-city neighborhoods in Boston. The conclusions drawn from the Institute's experience are corroborated by other scientific studies. First, the sociocultural characteristics of the community or group selected for study must be considered in planning and implementing any survey research on minority populations. Second, ensuring the quality of field work with minority groups may be expensive because of high residential mobility and lack of preexisting sampling frames. Third, there is no reason to expect any diminution of data quality with minority groups, provided the resources for data collection are adequate. The quality of data is undoubtedly proportional to the field efforts expended, but the costs of high-quality survey work are often not appreciated. The paper questions the utility of the term "minority research," for it disregards the considerable variation between and within minority groups and subcultures.

Black or African American↗
PubMed1991

The effect of widowhood on health: a prospective analysis from the Massachusetts Women's Health Study.

Previous research has consistently demonstrated adverse physical and psychological effects following the death of a spouse. Conclusions regarding the effects of widowhood have been hampered, however, by such methodological limitations as lack of adequate comparison groups, non-random samples of the widowed, and lack of data on pre-widowhood status. This paper examined the physical and psychological effects of widowhood in a randomly sampled cohort of women, aged 45-55 years at baseline, who were followed prospectively for five years. Analyses employed a design in which women whose spouses died during the course of the study (N = 76) were compared to age-matched married controls (N = 1625). The following two questions were addressed: (1) What are the physical and psychological effects of widowhood? and (2) What is the effect of widowhood on socioeconomic factors, social support and health behavior? Following the death of a spouse, the percentage of widows reporting psychological symptoms increased. The widows did not report higher rates of physical symptoms or a decrease in health. Widows had higher rates of health care utilization, in particular, taking prescribed medication, which were in part for mental health reasons. There was no evidence of changes in health behaviors among the widows, but social support increased following widowhood and more widows reported a decrease in income. The results highlight the importance of controlling for pre-widowhood status when studying the consequences of widowhood and provide additional evidence that widowhood may not adversely affect physical health for women.

Female↗
PubMed1991

Bringing social structure back into clinical decision making.

Although research in the past twenty years has resulted in an increasingly sophisticated understanding of clinical decision making processes, the dominant approach in this area of inquiry remains limited. Most studies emphasize normative models of how decisions ought to be made, others attempt to describe physicians' thinking, but few take the social context of decision making systematically into account. Research models typically assume that physicians are autonomous professionals practicing in socially insular clinical settings--an approach that is consistent with classic formulations of the social structure of medical practice, but they ignore 30 years of sociological research on research on patient-physician relationships and major historical changes in the structure of medical practice. Eisenberg's still timely advice to students of clinical decision making--that they need to describe decision making in the context of 'sociologic influences' (including patient, physician and practice setting characteristics)--is expanded in the present discussion. Recent studies are reviewed, highlighting important dimensions of social structure impinging on physicians' decision making. Findings indicate that the process of clinical decision making is likely influenced by patients' age, gender, socioeconomic status, and race, physicians' professional training and experience, as well as by larger structural features of organized clinical settings. Our review of these studies on the social context of clinical decision making, however, reveals major methodological limitations including those inherently imposed by secondary data analysis, normative approaches, written case vignettes, small, non-random samples and the inadequate control of confounding influences. We present a feasible, alternative research strategy, built on a factorial experimental design. Illustrative findings indicate how complex social structural influence on clinical decision making may be disentangled in an unconfounded manner.

Age Factors↗
PubMed1991

An examination of research design effects on the association of testosterone and male aging: results of a meta-analysis.

The study of testosterone is likely to be prominent in future epidemiological work on endocrine function and the clinical treatment of age-related diseases. Thus, understanding the hormonal changes involved in the normal male aging process will be critical. Using techniques of meta-analysis, the authors examined 88 published studies of the age-testosterone relation in men. These studies reported conflicting results: age-testosterone correlations ranged from -0.68 to +0.68. In cross-study comparisons, certain research design characteristics (e.g. time of day of blood sampling) and various sample characteristics (e.g. volunteers vs patients as subjects) were related to both mean testosterone level and the slope of the age-testosterone relation. For example, for subgroups of subjects that did not exclude ill men, the mean testosterone levels were low, and did not decline with age. Subgroups that included only healthy subjects, in contrast, had higher overall testosterone levels and showed a decline of testosterone with age. Implications of these results for design, analysis and reporting of future epidemiologic studies will be discussed. These results also illustrate the utility of meta-analysis for research with the aged.

Adult↗
PubMed1991

Reliability and physiologic correlates of the Harvard Alumni Activity Survey in a general population.

The reliability of the Harvard Alumni Activity Survey (HAAS) and its association with physiologic measures was assessed in a large sample of men and women aged 25-65 years residing in the Boston metropolitan area in 1987. Reliability was estimated by comparing HAAS energy expenditure reports (kcal/week) from two separate interviews conducted 7-12 weeks apart. The test-retest reliability coefficient was 0.58 for the entire sample, but was considerably higher (r = 0.69) for those whose activity patterns had not changed from one interview to the next. HAAS self-reports were compared to two physiologic measures known to be affected by physical activity: high density lipoprotein cholesterol (HDLC) and body mass index (BMI). The natural logarithm of weekly HAAS expenditures was positively correlated with HDLC (r = 0.14, p less than 0.01) and negatively correlated with BMI (r = 0.13, p less than 0.01) for all respondents. These statistically significant associations persisted when adjusted for other covariates influencing physiologic status. The reliability coefficients and physiologic correlations for the HAAS in this sample are comparable to those reported for physical activity instruments requiring more intensive data collection and scoring procedures.

Adult↗
PubMed1991

Age, disease, and changing sex hormone levels in middle-aged men: results of the Massachusetts Male Aging Study.

To evaluate the hypothesis that endocrine profiles change with aging independently of specific disease states, we examined the age trends of 17 major sex hormones, metabolites, and related serum proteins in 2 large groups of adult males drawn from the Massachusetts Male Aging Study, a population-based cross-sectional survey of men aged 39-70 yr conducted in 1986-89. Group 1 consisted of 415 men who were free of obesity, alcoholism, all prescription medication, prostate problems, and chronic illness (cancer, coronary heart disease, hypertension, diabetes, and ulcer). Group 2 consisted of 1294 men who reported 1 or more of the above conditions. Each age trend was satisfactorily described by a constant percent change per yr between ages 39-70 yr. Free testosterone declined by 1.2%/yr, and albumin-bound testosterone by 1.0%/yr. Sex hormone-binding globulin (SHBG), the major serum carrier of testosterone, increased by 1.2%/yr, with the net effect that total serum testosterone declined more slowly (0.4%/yr) than the free or albumin-bound pools alone. Among the major androgens and metabolites, androstane-3 alpha,17 beta-diol (androstanediol; 0.8%/yr) and androstanediol glucuronide (0.6%/yr) declined less rapidly than free testosterone, while 5 alpha-dihydrotestosterone remained essentially constant between ages 39-70 yr. Androstenedione declined at 1.3%/yr, a rate comparable to that of free testosterone, while the adrenal androgen dehydroepiandrosterone (3.1%/yr) and its sulfate (2.2%/yr) declined 2-3 times more rapidly. The levels of testosterone, SHBG, and several androgen metabolites followed a parallel course in groups 1 and 2, remaining consistently 10-15% lower in group 2 across the age range of the study. Subgroup analyses suggested that obese subjects might be responsible for much of the group difference in androgen level. Serum concentrations of estrogens and cortisol did not change significantly with age or differ between groups. Of the pituitary gonadotropins, FSH increased at 1.9%/yr, LH increased at 1.3%/yr, and PRL declined at 0.4%/yr, with no significant difference between groups 1 and 2.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1991

The validity of health risk appraisals for coronary heart disease: results from a randomized field trial.

BACKGROUND: While health risk appraisals (HRAs) are becoming increasingly popular as tools for health assessment and health education, comparatively little is known about the accuracy of these risk estimates. METHODS: A field trial among 732 randomly selected adults ages 25 to 65 years was conducted to assess the validity of the risk scores produced by four widely used HRAs. RESULTS: Self-reported HRA risk scores for cigarette smoking and relative weight were generally accurate, but correlations between physiological measurements and scores for blood pressure, cholesterol, and physical activity were always lower than .51. Correlations between epidemiologic estimates of the probability of CHD death and HRA total risk scores ranged from .13 to .75; partial correlations adjusting for age, race, and gender ranged from .12 to .47. CONCLUSIONS: The HRAs chosen for the field trial exhibited modest correlations with the CHD mortality risk predicted by the epidemiologic model. Mathematical errors made by respondents completing self-scored instruments and lack of knowledge regarding physiologic status decrease the accuracy of HRA risk estimates.

Adult↗
PubMed1990

The validity of self-reported exercise-induced sweating as a measure of physical activity.

The validity of self-reported hours in which one engages in activities strenuous enough to produce sweating was assessed as a measure of physical activity. Respondents were 732 randomly selected adults between the ages of 25 and 65 years from the Boston, Massachusetts, metropolitan area who participated in a field trial of health risk appraisal instruments in 1987. A total of 68% of the men and 57% of the women in the sample were involved in sweat-inducing activities at least once per week. The correlation between the natural logarithm of reported sweat hours per week and energy expenditure measured by the Harvard Alumni Activity Survey was 0.39. Following a logarithmic transformation and adjustment for age and sex, sweat hours was significantly correlated with high density lipoprotein cholesterol (r = 0.11, p less than 0.05). However, these associations were not as strong as those found for the age- and sex-adjusted log of the Harvard Alumni Activity Survey score (r = 0.19 and r = -0.15 for high density lipoprotein cholesterol and body mass index (weight (kg)/height(m)2), respectively) and are considerably weaker than those reported in other studies using sweat episodes (days per week on which sweating occurred) as an indicator of physical activity. These results suggest that the utility of self-reported sweat hours may be limited to distinguishing active from inactive subjects in epidemiologic surveys.

Adult↗
PubMed1990

How important is functional status as a predictor of service use by older people?

In studies of older people, it is often assumed that biophysical, or functional, status is the primary determinant of formal service use. This article reports baseline data from a longitudinal study of a community-based, linked random sample of frail elders (n = 635) and their informal caregivers (n = 429) to investigate the relative contribution of social circumstances to the use of community-based formal services. Elder respondents were categorized into three groups defined by their primary source of care: (a) informal only, (b) mixed help with predominantly informal care, (c) mixed help with predominantly formal services. Of the respondents, 79% received most of their help from informal caregivers, whereas 21% relied on formal services for most of their assistance. A series of logistic regression models were developed to identify variables that discriminated between major sources of care. The social factor of living alone is the consistent predictor of reliance on formal services. Only for those elders living alone does the physical factor of level of frailty predict reliance on formal services. Elders who live with a caregiver, particularly a spouse, are likely not to use any formal services regardless of their level of frailty. Finally, elders reliant on formal services receive much less care overall.

Activities of Daily Living↗
PubMed1989

The questionable physiologic and epidemiologic basis for a male climacteric syndrome: preliminary results from the Massachusetts Male Aging Study.

This paper examines the physiologic and epidemiologic evidence for a widely discussed syndrome termed either 'mid-life crisis', 'male menopause', 'male climacteric', or increasingly, 'andropause'. The paper is divided into 2 parts: (1) a review of evidence from physiologic studies conducted over the last decade that examine endocrine function in aging males; (2) a description of the salient features of an ongoing multidisciplinary epidemiologic study (the Massachusetts Male Aging Study) of a sample of approximately 1700 men aged 40-69 yr, randomly sampled from the general population. This study is markedly different in size and content from studies conducted to date. Preliminary findings suggest that age per se may be a relatively unimportant contributor to endocrine variability and that anthropometrics and life style phenomena may be at least as important.

Adult↗
PubMed1989

Informal care for frail elders: the role of secondary caregivers.

Although the majority of informal care is provided by one person, most elders receive help from other caregivers as well. This paper describes the identity and activities of these secondary caregivers, who are often the spouse and children of the primary caregiver. They provide a wide variety of help, but much less than the primary caregiver. Further, this help is provided in a pattern supplementary rather than complementary to that of the primary caregiver.

Aged↗
PubMed1989

The reliability of health risk appraisals: a field trial of four instruments.

A field trial was conducted to evaluate the reliability of four widely used health risk appraisals (HRAs). A total of 338 randomly selected adults aged 25 to 65 years residing in the Boston metropolitan area completed an HRA on two occasions seven to 12 weeks apart. Test-retest reliability was assessed by comparing self-reported baseline risk scores to follow-up scores for heart attack risk and selected coronary heart disease risk factors. Respondents generally gave consistent reports for family history, cigarette smoking, and relative weight (test-retest r greater than .75), but self-reported scores for physiologic status (blood pressure and cholesterol) and lifestyle (diet, physical activity, and stress) were much less stable. Coefficients for heart attack risk and appraised age ranged from .43 to .87 for the four HRAs. The reliabilities of two self-scored instruments were greatly reduced by mathematical errors made by respondents when computing their heart attack risk scores. These results were not affected by the length of the follow-up period (seven to 12 weeks).

Adult↗