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Biomedical subjects

J B McKinlay

Publications and source records attributed to J B McKinlay.

At least 91 records · Page 5Linked to original sources
PubMed1989

Accuracy of perceptions of heart attack risk: what influences perceptions and can they be changed?

Using perceived risk of a heart attack, we examined the relative importance of perceived risk factors and sociodemographic variables on subjects' perception of heart attack risk, the relationship between perceived and objectively measured heart attack risk, and the effect of health risk appraisal (HRA) feedback on risk perceptions. Data derive from a random sample of 732 Greater Boston, Massachusetts area men and women ages 25-65 years, who participated in a field trial of health risk appraisal instruments. At baseline and approximately two months later, all respondents completed a questionnaire assessing their own health-related behavior, risk factors, and perception of heart attack risk. At baseline, respondents also completed one of four HRA instruments. Physiologic measures of cholesterol, blood pressure, and weight were taken at either baseline or follow-up visit. Results showed that respondents used established risk factors in estimating overall risk; that compared to objective measures of risk, a high percentage of respondents displayed an optimistic bias; and that HRA feedback had some effect on perception of heart attack risk for those at high risk. Implications of these results for health promotion are discussed.

Adult↗
PubMed1989

A review of the evidence concerning the impact of medical measures on recent mortality and morbidity in the United States.

Because it still is widely believed that one deadly disease after another is being eliminated, or diminished, largely because of medical interventions, there is little commitment to social change and even resistance to a reordering of national priorities. In this article we examine the contribution of medical measures to recent mortality changes in coronary heart disease, cancer, and stroke, which together account for two-thirds of total U.S. mortality and consume the vast majority of available resources. Morbidity changes are also examined and found to be not declining in a manner congruent with mortality and, in fact, increasing for some subgroups. Using a combined measure of mortality and morbidity (the probability of a life free of disability), it is demonstrated that although overall life expectancy has increased over several decades, most of this increase is in years of disability. Our late 20th century approach to the emerging AIDS pandemic (the frantic search for a "magic bullet"--either a treatment or a vaccine) belies any suggestion that the arguments and data presented concerning the modest contribution of medical measures are now passé.

Adult↗
PubMed1988

Corporatization and the social transformation of doctoring.

Corporatization of health care is dramatically transforming the medical workplace and profoundly altering the everyday work of the doctor. In this article, the authors discuss recent changes in U.S. health care and their impact on doctoring, and outline the major theoretical explanations of the social transformation of medical work under advanced capitalism. The adequacy of the prevailing view of professionalism (Freidson's notion of professional dominance) is considered, and an alternative view, informed by recent changes, is offered. While the social transformation of doctoring is discussed with reference to recent U.S. experience, no country or health system can be considered immune. Indeed, U.S. experience may be instructive for doctors and health care researchers in other national settings as to what they may expect.

Economic Competition↗
PubMed1987

Health status and utilization behavior associated with menopause.

Since menopause is increasingly implicated in the etiology of some major age-related diseases in women, such as cancer, cardiovascular disease, osteoporosis, and depression, there is a need to understand the epidemiology of this physiologic event which is universal for women. To date, knowledge of menopause is based on a small proportion of self-selecting, predominantly ill women. A stereotype has emerged of the "typical" menopausal woman, who presents a broad range of diffuse symptoms and is a higher utilizer of health care. This prevailing view is contradicted by prospective data gathered over 27 months on a cohort of approximately 2,500 women who are representative of women aged 45-55 years in Massachusetts. It is demonstrated that menopause itself does not cause poorer health status (either physical or psychologic); menopause itself does not cause an increase in utilization behavior; occurrence of a surgical menopause is the primary menopause-related change associated with subsequent perceived health status and utilization behavior, and then only minimally; and almost all the explained variability in health status and utilization behavior outcomes is attributable to the prior health status of the respondents and, to a lesser extent, to utilization behavior. These findings underscore the importance of two methodological requirements for future work: representative samples of apparently healthy women; and prospective data which elucidate cause-effect relations.

Analysis of Variance↗
PubMed1986

Aging in a 'healthy' population.

A five-year project, building on an ongoing epidemiological study of menopause in 2500 women, will examine the aging process in middle-aged and older men, women, and couples in Massachusetts. While past research on aging has usually focused on disease and has drawn on a self-selecting, usually clinical population, our study will examine healthy individuals randomly selected from the general population. This approach should allow for increased inferential power of findings on how positive adjustment to the aging process occurs. The project is multi-disciplinary, combining physiological measurements (hormone levels, bone densities, etc.) with psychosocial data, and draws on previous experience with community-based methods of collecting physiological and psychological information in large health surveys.

Aged↗
PubMed1985

Towards the proletarianization of physicians.

The thesis of this article is that in general where most other workers were quickly and easily proletarianized, physicians - through the use of a variety of tactics at the disposal of some elite groups - have, until now, been able to postpone or minimize this process in their own case. Now, as a result of the bureaucratization which is being forced on medical practice as a consequence of the logic of capitalist expansion, physicians are slowly being reduced to a proletarian function, and their formerly self-interested activities subordinated to the broader requirements of the capitalist control of highly profitable medical production.

Economic Competition↗
PubMed1985

Smoking and age at menopause in women.

Although women can expect to live one half of their adult lives beyond menopause, knowledge about this physiologic event and its various influences on subsequent health and quality of life remains incomplete. In Massachusetts we studied a population-based random sample of 7828 white women, aged 45 to 55 years (response rate, 77%). The median age at last menstruation for the sample is 51.4 +/- 0.19 (SE) years years, and we found no evidence of a secular trend towards a later age at menopause in the last 25 years. Current smokers reach menopause an average of 1.74 years earlier than nonsmokers (t = 3.78, p less than 0.01), but the quantity smoked has a negligible effect. Other potential correlates measured--education and marital status, number of children, and urban/rural residence--have little effect on the age at menopause. The results confirm earlier, more tentative findings from clinical populations.

Age Factors↗
PubMed1980

Evaluating medical technology in the context of a fiscal crisis: the case of New Zealand.

Planning for health services in New Zealand, and the implications of increasing use of high technology, fail to take account of the mounting crisis in the country's economy. Social policy that ignores structural problems in the economy or the system of medical care is unrealistic. A strategy is advanced to determine what resources are likely to be available, and how they can be allocated to ensure value for money. The situation is not unique to New Zealand.

Diffusion of Innovation↗
PubMed1979

The influence of a premarital conception and various obstetric complications on subsequent prenatal health behaviour.

This paper is a companion to an earlier report on prenatal visiting patterns in Aberdeen, Scotland (McKinlay, 1970). It examines the following three main questions: (1) Is the emerging trend towards later maternity care among young nulliparae largely due to those who delay because of premarital conception? (2) If premarital conception is primarily responsible for this trend, is this pattern of visiting behaviour continued in subsequent pregnancies, and what variation is there in such behaviour--between, for example, different socioeconomic groups and age groups? (3) Does the presence of one or more obstetric complications associated with a first pregnancy or birth have an effect on subsequent prenatal health behaviour, and does this effect, if present, interact with, say, socioeconomic status, or the legal status of the first pregnancy? The paper concludes with a discussion of some policy implications of the findings.

Adult↗
PubMed1977

The business of good doctoring or doctoring as good business: reflections on Freidson's view of the medical game.

This paper reflects on selected aspects of the work of Eliot Freidson and is based mainly on his three latest books--Profession of Medicine, Professional Dominance, and Doctoring Together--in which he draws together his various contributions and elaborates a substantial argument concerning the dominant position of physicians within the institution of medicine in particular and, more generally, their unique position within the broader society. Freidson's work is considered from the perspective of political economy. The paper discusses, on a broad level, some of the assumptions underlying his analysis, the adequacy of his theoretical orientation and level of analysis for understanding the House of Medicine in the United States, and some implications that follow.

Economics, Medical↗