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S M McKinlay

Publications and source records attributed to S M McKinlay.

At least 37 records · Page 2Linked to original sources
PubMed1991

A longitudinal analysis of women's attitudes toward the menopause: results from the Massachusetts Women's Health Study.

This paper examines women's attitudes towards menopause in a large representative sample of middle-aged women. Data were derived from the Massachusetts Women's Health Study (MWHS) which is a prospective study of 2565 women aged 45-55, randomly sampled throughout Massachusetts. The paper addressed the following questions: (1) What are women's attitudes towards the menopause and how do attitudes change as a function of menopause? (2) What variables are related to attitudes towards menopause? and (3) Do attitudes towards menopause predict subsequent symptom reporting during menopause? Results showed that the majority of women reported relief or neutral feelings about the cessation of menses and that feelings became more positive as women experienced menopause. Negative attitudes towards menopause were related to general symptom reporting and depression. Additionally, negative attitudes prior to menopause were related to subsequent symptom reporting during menopause. These results suggest that the so-called menopause syndrome may be more related to personal characteristics than to menopause per se.

Attitude to Health↗
PubMed1991

Use of estrogens among middle-aged Massachusetts women.

This study describes estrogen use among 45- to 55-year-old white women in Massachusetts from 1981 to 1987. In a 1981 cross-sectional survey, 7705 white women (77 percent response rate) returned a questionnaire or were interviewed by phone. Premenopausal women were invited into a 4.5-year follow-up study including telephone interviews every nine months, and 2236 (approximately 91 percent of the eligible women) had a complete follow-up. In the cross-sectional survey, 7.9 percent had used oral estrogens in the last two weeks, but most (77 percent) had had a hysterectomy; use varied notably from one area to another. Vaginal estrogens were used by 2.9 percent. Users and nonusers of oral estrogens were quite similar in regard to sociodemographic background. Data from the follow-up surveys showed that estrogen use increased throughout the study period and by the final follow-up women with higher education status reported more estrogen use than those with lower education status. Most women used estrogens only for a short time.

Drug Utilization↗
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

Direct relationship of antepartum glucose control and fetal erythropoietin in human type 1 (insulin-dependent) diabetic pregnancy.

In the present study the antepartum relationship between maternal diabetic glucose control and fetal hypoxaemia was examined in 44 Type 1 (insulin-dependent) diabetic and 23 non-diabetic control pregnancies. Maternal HbA1C was used to assess maternal integrated blood glucose control while fetal metabolic control was evaluated by antepartum glucose, insulin, and C-peptide determinations in amniotic fluid at elective caesarean delivery. Fetal hypoxaemia was assessed indirectly by fetal umbilical vein plasma erythropoietin level at delivery. A prospectively developed statistical pathway model was used to examine the relationship of these variables. In applying forced stepwise multiple regression with this model, we observed in the diabetic subjects that mean maternal HbA1C during the last month of pregnancy correlated significantly with fetal umbilical venous erythropoietin at delivery (r = 0.57, p less than 0.001). Additional significant contributions to umbilical venous erythropoietin were found for amniotic fluid glucose and amniotic fluid insulin when these two independent variables were added in stepwise fashion (p less than 0.01). We conclude that in diabetic pregnancy, antepartum control of maternal hyperglycaemia is a significant factor associated with fetal hypoxaemia. We speculate that this effect is mediated through perturbations which accelerate fetal metabolism and which is expressed by amniotic fluid levels of glucose and insulin.

Amniotic Fluid↗
PubMed1990

The relationship of total and free estrogens and sex hormone-binding globulin with lipoproteins in women.

To determine whether there was a significant relationship between circulating lipids or lipoproteins and circulating estrogens or sex hormone-binding globulin (SHBG) in pre- and premenopausal women, 352 women were chosen randomly from communities in Eastern Massachusetts. These women had nonfasting blood samples drawn and analyzed for total cholesterol, high density lipoprotein cholesterol (HDL-C), HDL-2, HDL-3, apolipoprotein-A-I (apo-A-I), apo-B, triglycerides (TG), estrone, estradiol (E2), free E2, SHBG, and FSH. In addition, their body mass index (BMI; wt/ht2) was calculated, and a history of smoking, ethanol intake, current medication use, and the date of their last menstrual period was obtained. When the women were grouped according to the months from their last menses (less than 1, 1-3, and 4-11 months), those 4 months or longer since last menses had significantly lower E2 concentrations and significantly greater total cholesterol and FSH concentrations than the other two groups. However, when regressed on hormones, BMI, ethanol intake, and last menstrual period, total cholesterol was significantly related only to the time from last menses; TG, HDL-C, HDL-2, and apo-A-I were related to SHBG. Relationships between the lipids, with the exception of cholesterol and apo-B, were also noted with BMI and/or ethanol. Apo-B was related to the time from last menses. Differences in circulating estrogens appeared to be related only minimally, if at all, to the differences in total cholesterol that are seen in perimenopausal women. The relationships between lipids and lipoproteins and SHBG are probably epiphenomena as a result of similar sites of synthesis. Changes in lipids and lipoproteins that are seen at the time of the menopause are probably multifactorial in origin.

Amenorrhea↗
PubMed1989

A prospective study of factors affecting age at menopause.

This paper describes a multivariate analysis of a 3-year prospective study of the covariates of age at menopause among women who were randomly sampled from a general population. This approach avoids three problems that may account for the inconsistent results of prior studies: recall bias in retrospectively collected data, failure to control confounding in data analyses, and self-selection in the target populations. At baseline, the 2014 subjects in this study were 46.5-56.5 years old and still menstruating. Median age at last menstruation estimated from a model of the marginal distribution of age at menopause, was 50.7 years. When covariates were considered singly, age at menopause varied with smoking, education and income but not with marital status, parity, location, height, weight or use of either oral contraceptives or menopausal estrogens. Multivariate analyses showed that education and income were confounded with smoking status. The results indicate that many previously identified sources of variation in age at menopause reflect confounding with smoking and self-selection in target populations, rather than real effects.

Adult↗
PubMed1989

A new approach to surveillance for acute myocardial infarction: reproducibility and cost efficiency.

A new approach to surveillance of myocardial infarction, the major cardiovascular endpoint is described using an algorithm which depends primarily on enzyme data, using evidence of chest pain and positive electrocardiogram findings as supplemental information only. This approach is evaluated with respect to reproducibility by minimally trained abstractors, cost, and robustness with respect to different hospital systems as well as changes in diagnostic techniques and/or labelling over time. Two pilot studies demonstrate that, in comparison to more traditional approaches, the new surveillance system provides at least a 50% reduction in cost, is highly reproducible over different hospital systems, and potentially, is resilient to changes in diagnostic procedures or coding. The more general applicability of such an innovative surveillance approach to other disease endpoints, in which one reliable procedure contains most of the diagnostic information, is discussed with particular reference to cancer.

Algorithms↗
PubMed1989

Research design and analysis issues.

The overall perspective of this article is the need for researchers of school-based health promotion to make more progressive use of existing statistical methods to improve both the rigor and the efficiency of school-based experiments. Investigative teams working in the school setting have an advantage over health education researchers working in communities or worksites in that they have greater choice of the experimental unit and usually easier access to large clusters of units. They are, therefore, in a position to make optimal use of a wide variety of experimental designs and observation strategies. In order to make full use of this advantage, however, researchers in this field need to assemble multidisciplinary teams, including researchers from other fields who are not restricted by the traditional approaches evident in many of the current school studies. Such teams should include statisticians and epidemiologists who have broadly-based experimental design and survey experience to work with the health educators and other behavioral and biomedical scientists.

Data Interpretation, Statistical↗
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↗
PubMed1989

A comparison of perceived and objective CVD risk in a general population.

This report examines correspondence between perceived and objective (American Heart Association's RISKO) risk of heart attack and stroke in a randomly selected sample from two surveys (n = 4,171) conducted in each of two New England cities, in 1981-82 and 1983-84, respectively. Results confirmed prior reports that people tend to underestimate their CVD (cardiovascular disease) risk and showed that estimates of those at lowest risk were most accurate.

Adolescent↗
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

Prescribing of noncontraceptive estrogens and progestins in the United States, 1974-86.

This paper describes changes in the prescribing of noncontraceptive estrogens and progestins, using data from pharmaceutical marketing surveys. The number of estrogen prescriptions decreased from 1975 to 1980, and then increased through 1986. Progestin use has increased since 1982; concomitant use of estrogens and progestins increased over time and was common in 1986. The trends suggest that the use of estrogens, particularly the combined use of estrogens and progestins, will continue to increase.

Adult↗
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↗
PubMed1987

A comparison of responses to mailed questionnaires and telephone interviews in a mixed mode health survey.

This paper compares respondents to mailed questionnaires with those nonrespondents subsequently interviewed by telephone in a survey of Massachusetts women aged 45-55 years conducted in 1981-1982. This mixed mode approach produced 8,050 responses, giving a response rate of 77%. This rate is similar to rates obtained in many surveys that employed in-person interviews, which are still widely used in health surveys but are increasingly expensive. Telephone respondents differed socioeconomically from mail respondents, suggesting that telephone follow-up of nonrespondents may have reduced nonresponse bias in this survey. Thus, a mixed mode approach may be superior to a mail-only approach with respect to this aspect of data quality. Women responding by mail were more likely to hold professional jobs, to have relatively high household incomes, and to have more years of education. Controlling for these socioeconomic differences did not, however, remove differences in reported health outcomes between mail and telephone respondents. These differences may be explained by less complete recall in the telephone interviews or they may arise from actual differences in health profiles between early (i.e., mail) and late (i.e., telephone) respondents. Although a mixed mode approach may reduce nonresponse bias, more research is required concerning the reasons for response differences between modes and to eliminate any differences caused by problems in data quality.

Female↗
PubMed1987

The validity of health risk appraisal instruments for assessing coronary heart disease risk.

This study evaluated the validity of the scoring systems employed by 41 health risk assessment instruments (HRAs) with respect to the probability of death due to coronary heart disease. Validity was assessed by comparing predictions of mortality risk produced by each HRA to estimates from the Framingham Heart Study and the Risk Factor Update Project. Correlations with both epidemiologic estimates indicated that instruments employing logistic regression or the Geller/Gesner methodology had the highest validity coefficients, while validity was lowest for self-administered general health status and lifestyle questionnaires. However, most instruments using the Geller/Gesner technique appear to systematically overestimate the probability of CHD mortality. For HRAs based on additive risk scales, validity was often attenuated by the crude categorization of some risk factors and by the omission of the effects of age from the scoring system.

Adult↗