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Biomedical subjects

M Woodward

Publications and source records attributed to M Woodward.

At least 55 records · Page 3Linked to original sources
PubMed2001

Screening for human papillomavirus infection in asymptomatic women in Hungary.

BACKGROUND: A multicentre epidemiological survey was carried out in order to determine the prevalence of, and risk factors for, persistent cervical human papillomavirus (HPV) infection in women in Hungary. METHODS AND RESULTS: A total of 728 women were examined for the prevalence of HPV. The estimated overall rate of HPV infection was 17%. In univariate analysis the strongest predictors were young age (< or =24 years), unmarried family status, smoking, a pathological Papanicolaou (Pap) smear, having a condyloma and previous gynaecological cancer in the family (age and marital status being the most important predictors). In multiple regression analysis, young age (< or =24 years)(odds ratio = 1.86, 95% confidence interval = 1.19-2.90, P < 0.01), smoking (1.78, 1.17-2.71, P < 0.05), an abnormal Pap smear (6.92, 2.68-17.84, P < 0.001), having a condyloma (4.22, 1.42-12.58, P < 0.01) and living in a region where the unemployment rate is relatively high (1.56, 1.24-2.82, P < 0.01) were associated risk factors for HPV infection. CONCLUSIONS: The prevalence of HPV infection in young women in Hungary is high. Screening for HPV is suggested only in women with an unfavourable gynaecological history who are < or =24 years old.

Adult↗
PubMed2001

Cardiovascular risk factors, including thrombotic variables, in a population with rheumatoid arthritis.

OBJECTIVE: To compare prevalent cardiovascular disease, conventional cardiovascular risk factors and thrombotic variables in a cohort with well-controlled rheumatoid arthritis (RA) and in population controls. METHODS: Seventy-six RA patients and 641 controls, randomly sampled from the local population in the North Glasgow MONICA study. Conventional cardiovascular risk factors (blood pressure, smoking, cholesterol) and thrombotic variables [fibrinogen, von Willebrand factor (vWF), tissue plasminogen activator antigen (t-PA), fibrin D-dimer, plasminogen activator inhibitor (PAI-1), plasma viscosity] were measured by standard procedures. RESULTS: RA patients had a significantly higher prevalence of angina pectoris (P=0.03). Stroke also tended to be more common in the RA group, but the difference did not reach statistical significance (P=0.08). Diastolic blood pressure was significantly higher and serum cholesterol significantly lower in the RA group than in controls. Current smoking habits and exercise history were similar in the two groups, although RA patients were more likely to have previously smoked. Significant elevations in several thrombotic predictors of cardiovascular disease (fibrinogen, vWF, t-PA antigen and fibrin D-dimer) were found in the RA group. CONCLUSIONS: In this RA patient population, diastolic blood pressure was higher than in controls and thrombotic variables were elevated compared with controls. These features are identified as potential additional cardiovascular risk factors in the RA patients studied. Prospective studies of risk modification may permit the identification of factors which could lead to a reduction in the known increased cardiovascular risk in RA.

Adult↗
PubMed2001

Efficacy of an angiotensin II receptor antagonist in managing hyperaldosteronism.

OBJECTIVE: To determine whether an angiotensin II receptor antagonist decreases blood pressure in patients with hyperaldosteronism and hypertension who are taking other antihypertensive agents. DESIGN: A double-blind randomized placebo-controlled crossover study. PATIENTS AND METHODS: Blood pressure and hormonal responses to 2-week courses of placebo/irbesartan (150 mg/day given by mouth at 08.05 h) were assessed in 10 patients with hyperaldosteronism. Clinic blood pressure was measured by sphygmomanometer, and plasma concentrations of aldosterone, cortisol, angiotensin II, electrolytes and renin activity (PRA) were determined weekly. Automated 24 h ambulatory blood pressure recordings were made at the end of the active and placebo phases. RESULTS: Irbesartan caused a post-dose decrease in ambulatory blood pressure (systolic, P = 0.02; diastolic, P = 0.05) in the period from 10.00 h to 20.00 h. Clinic blood pressure, measured at trough, was not significantly decreased. Plasma aldosterone decreased (P < 0.03) and PRA increased (P < 0.04) in the first week of active treatment with irbesartan, but differences between the placebo and active-treatment groups were not significant in the second week. There were no significant changes in plasma concentrations of angiotensin II, cortisol or potassium in either week. In the second week of irbesartan treatment, there were associations between change in plasma aldosterone and maximal change in ambulatory blood pressure (systolic and diastolic). CONCLUSION: Irbesartan has a role in combination antihypertensive treatment of patients with hyperaldosteronism.

Adult↗
PubMed2001

Helicobacter pylori infection reduces systemic availability of dietary vitamin C.

OBJECTIVE: Helicobacter pylori infection is recognized to lower the concentration of vitamin C in gastric juice. The objective of this study was to assess the effect of the infection on the systemic availability of dietary vitamin C. METHODS: The study involved 1,106 men and women aged 25-74 randomly recruited from the population of north Glasgow. Their H. pylori status, dietary vitamin C intake calculated from a food frequency questionnaire and plasma vitamin C concentration were measured. Correction was made for potential confounding factors such as age, sex, smoking and social status. RESULTS: The mean plasma vitamin C concentration in those who were H. pylori-positive was only 65% of that in those classified negative. Although partly explained by differences in age, sex, social class, smoking and vitamin C intake, the systemic reduction was observed across almost all sub-groups after stratification. Correction for all these factors still gave a plasma vitamin C level for H. pylori positives which was only 80% of that for negatives (P < 0.0001). CONCLUSIONS: H. pylori substantially impairs the bio-availability of vitamin C. This, together with the reduced vitamin C intake of H. pylori-positive subjects, markedly reduces the plasma vitamin C level of infected subjects. The reduced circulating levels of vitamin C in H. pylori-infected subjects may contribute to the aetiology of gastric cancer, as well as other diseases associated with anti-oxidant deficiency.

Adult↗
PubMed2001

Forgiveness. A concept analysis.

This article provides an operational definition of forgiveness as a first step in the systematic analysis of the concept. Using the method described by Walker and Avant (1995), the authors identify the attributes and characteristics of forgiveness and its theoretical and practical implications for nursing. Sample cases from clinical practice help illustrate the concept further. Further nursing research needs to test the theoretical relationships between forgiveness and nursing practice outcomes.

Attitude↗
PubMed2001

Chlamydia trachomatis infection and the risk of perinatal mortality in Hungary.

INTRODUCTION: Chlamydial infections of the genital tract are thought to often lead to preterm birth, which is the most important perinatal problem in Hungary. AIM OF STUDY: A multicenter study was carried out to determine the prevalence of Chlamydia trachomatis infection, risk factors for the infection and to relate the infection to perinatal mortality, accounting for potential confounding effects. METHODS: The nucleic acid hybridization method (PACE2 Gen-Probe) was applied for the examination of Chlamydia trachomatis. Logistic regression analysis was used to assess risk. RESULTS: A total of 6156 pregnancy women were examined for the occurrence of Chlamydia trachomatis. The observed overall rate of chlamydial infection was 5.9%. Young age (less than 24 years old) (OR and 95% CI: 1.6 (1.3-2.0)), unmarried status (1.5 (1.2-1.9)) and the high unemployment rate (2.1 (1.6-2.7)) were statistically significant predictors of the infection. In logistic regression analysis, chlamydial infection (1.9 (1.1-3.3)), high unemployment rate (1.5 (1.2-2.2)) and low birth weight (1.7 (1.1-2.7) were significant predictors of perinatal mortality. CONCLUSIONS: Testing pregnant women for diseases that can be transmitted perinatally is an important part of obstetric care. Screening for C. trachomatis of unmarried women under 24 years of age is suggested and need increased observation during labor.

Adult↗
PubMed2000

Development of an ultralow-light-level luminescence image analysis system for dynamic measurements of transcriptional activity in living and migrating cells.

We have developed an approach to study in single living epithelial cells both cell migration and transcriptional activation, which was evidenced by the detection of luminescence emission from cells transfected with luciferase reporter vectors. The image acquisition chain consists of an epifluorescence inverted microscope, connected to an ultralow-light-level photon-counting camera and an image-acquisition card associated to specialized image analysis software running on a PC computer. Using a simple method based on a thin calibrated light source, the image acquisition chain has been optimized following comparisons of the performance of microscopy objectives and photon-counting cameras designed to observe luminescence. This setup allows us to measure by image analysis the luminescent light emitted by individual cells stably expressing a luciferase reporter vector. The sensitivity of the camera was adjusted to a high value, which required the use of a segmentation algorithm to eliminate the background noise. Following mathematical morphology treatments, kinetic changes of luminescent sources were analyzed and then correlated with the distance and speed of migration. Our results highlight the usefulness of our image acquisition chain and mathematical morphology software to quantify the kinetics of luminescence changes in migrating cells.

Animals↗
PubMed2000

An investigation into factors associated with Helicobacter pylori infection.

This study aims to estimate the prevalence of Helicobacter pylori in Glasgow, and to provide a systematic analysis of factors associated with this prevalence. The data used are from a random population sample of 793 men and 838 women aged 25-64 years conducted in 1995. The prevalence is estimated to be 66% (95% confidence interval: 63-68%); a level that is more typical of developing countries. Prevalence increases with age and social deprivation (P<0.0001) and is slightly higher in men than women (P = 0.07). After adjustment for age, social class, and sex group, H. pylori prevalence increases with increased cotinine (tobacco consumption) (P = 0.0005), increased number of siblings (P<0.0001), and decreased height (P = 0.03). Prevalence of coronary heart disease, hypertension, diabetes and intermittent claudication, alcohol consumption, fibrinogen, total serum cholesterol, HDL cholesterol, triglycerides, marital status, systolic and diastolic blood pressure had no independent association. The infection seems to be spread more readily in deprived, relatively crowded living conditions in childhood. The independent relationship with smoking suggests a possible second source of spread of infection in later years. The high degree of social deprivation in Glasgow is suggested as a major explanation of the high H. pylori prevalence found there.

Adult↗
PubMed2000

Accuracy of the estimated prevalence of obesity from self reported height and weight in an adult Scottish population.

STUDY OBJECTIVE: To determine whether self reported heights and weights from Scottish adults can provide an accurate assessment of obesity prevalence in the population. DESIGN: Standardised clinic measurements of weight and height were compared against self reported values on a postal questionnaire in the fourth Scottish MONICA cross sectional study. SETTING: A sex and five year age band stratified random population sample drawn from general practitioner registers in north Glasgow in 1995. Response rate 63% for men and 62% for women. PARTICIPANTS: A total of 865 men and 971 women aged between 25 and 64 years. RESULTS: Men and women under-reported their weight by a mean (SD) of 0.63 (3.45) kg and 0.95 (2.64) kg respectively, and their height by a mean (SD) of 1.3 (2.50) cm and 1.7 (2.37) cm respectively. Estimated body mass index, BMI (kg/m2) varied from true (measured) BMI by +0.19 (1.40) for men and by +0.17 (1.34) for women. The only age/sex group in which BMI was under-estimated from self reports (mean 0.2) was the 55-64 year old women. Prediction equations that explained 90% (men) and 88% (women) of the difference between self reported and measured height included age and self reported weight. The equivalent prediction equations for weight explained 93% of the difference between self reported and measured weight for men and included smoking and diabetic status, while for women 96% of the variance was explained with no further variables being significant. Sensitivity and specificity for determining clinical obesity (BMI > or = 30) were 83% and 96% respectively for men, and 89% and 97% for women. CONCLUSIONS: This Scottish population was unique in the under-reporting of height as well as weight, which resulted in BMI estimates with low error. These data suggest that self reported weights and heights would be satisfactory for the monitoring of obesity prevalence in Scotland.

Adult↗
PubMed2000

Thrombotic variables and risk of idiopathic venous thromboembolism in women aged 45-64 years. Relationships to hormone replacement therapy.

Hormone replacement therapy (HRT) has been shown to increase the relative risk of idiopathic venous thromboembolism (VTE) about threefold in several observational studies and one randomised controlled trial. Whether or not this relative risk is higher in women with underlying thrombophilia phenotypes, such as activated protein C (APC) resistance, is unknown. We therefore restudied the participants in a case-control study of the relationship between the use of HRT and the occurrence of idiopathic VTE in women aged 45-64 years. After protocol exclusions, 66 of the cases in the original study and 163 of the controls were studied. Twenty haematological variables relevant to risk of VTE were analysed, including thrombotic states defined from the literature. The relative risk of VTE showed significant associations with APC resistance (OR 4.06; 95% CI 1.62, 10.21); low antithrombin (3.33; 1.15, 9.65) or protein C (2.93; 1.06, 8.14); and high coagulation factor IX (2.34; 1.26, 4.35), or fibrin D-dimer (3.84; 1.99, 7.42). HRT use increased the risk of VTE in women without any of these thrombotic states (OR 4.09; 95% CI 1.26, 13.30). A similar effect of HRT use on the relative risk of VTE was also found in women with prothrombotic states. Thus for example, the combination of HRT use and APC resistance increased the risk of VTE about 13-fold compared with women of similar age without either APC resistance or HRT use (OR 13.27; 95% CI 4.30, 40.97). We conclude that the combination of HRT use and thrombophilias (especially if multiple) increases the relative risk of VTE substantially; hence women known to have thrombophilias (especially if multiple) should be counselled about this increased risk prior to prescription of HRT. However, HRT increases the risk of VTE about fourfold even in women without any thrombotic abnormalities: possible causes are discussed.

Activated Protein C Resistance↗
PubMed2000

Hypnotics. Options to help your patients stop.

BACKGROUND: There are a wide range of reasons why hypnotic agents may be started, but there is substantive evidence that they are often overused or misused. OBJECTIVE: To review the reasons for stopping hypnotic agents, how to detect their use, how to facilitate the decision to withdraw and how to most effectively achieve withdrawal. In this article, the target group is using but not intentionally abusing hypnotic agents. DISCUSSION: In many cases it is possible for patients to permanently stop using hypnotic drugs. Withdrawal can generally be achieved in the community, using a gradual taper regimen, although it is often a difficult process and is more effective when the patient is aware of the health benefits to be gained from withdrawal. Once withdrawn, other approaches to maintain sleep need to be reinforced to reduce the risk of recommencing hypnotic therapy.

Aged↗
PubMed1999

Dietary antioxidant vitamins and fiber in the etiology of cardiovascular disease and all-causes mortality: results from the Scottish Heart Health Study.

In this paper, data obtained between 1984 and 1993 from 11,629 men and women as part of the Scottish Heart Health Study (Scotland, United Kingdom) were used to investigate the relation between antioxidant vitamin and fiber intakes and both incident coronary heart disease (CHD) (649 events) and all-causes mortality (591 deaths). All age-adjusted mean intakes tended to be higher in the group that experienced no event. For men, increased fiber intake was associated with decreased risk of CHD even after adjustment for a host of other major coronary risk factors; hazard ratios relative to the lowest quarter were 0.68, 0.70, and 0.64 by increasing quarter. This relation was also observed for mortality (hazard ratios of 0.62, 0.66, and 0.62). Evidence was found that higher intakes of the antioxidants were also beneficial, although the associations were weaker. For women, fiber was the only obviously influential dietary factor, with hazard ratios of 0.94, 0.60, and 0.56 for CHD and 1.25, 0.82, and 0.65 for mortality. These results suggest that the current public health drive to increase the consumption of foods rich in antioxidant vitamins and (particularly) fiber will impact on both CHD risk and the general health of the population.

Adult↗
PubMed1999

The prevalence of dyspepsia and use of antisecretory medication in North Glasgow: role of Helicobacter pylori vs. lifestyle factors.

AIMS: To determine the prevalence of dyspepsia and associated antisecretory medication usage, and their associations with H. pylori infection in the general population. In addition, to compare the importance of H. pylori infection relative to other potential causes of dyspepsia: alcohol, smoking and obesity. METHODS: The study examined a random population sample of 784 men and 827 women from Glasgow. They completed a validated dyspepsia questionnaire and had their H. pylori status determined by serology. RESULTS: The overall prevalence of dyspepsia was 12%; prescribed antisecretory medication had been used over the last 6 months by 7%. The odds ratio (95% CI) for dyspepsia, comparing H. pylori-positives to negatives was 1.79 (1.03, 3.09) for men and 1.11 (0.70, 1.78) for women. Ever-smoking (both sexes) and obesity (women) had higher odds ratios for dyspepsia than did H. pylori. Adjustment for age, social class, ever-smoking, ever-drinking and obesity reduced the H. pylori odds ratios for dyspepsia to 1.38 (0.73, 2.60) for men and 0.99 (0. 57, 1.73) for women. The association between H. pylori and antisecretory medication usage was similar to that for dyspepsia. CONCLUSION: Obesity and smoking are more important risk factors, for dyspepsia and antisecretory medication usage, than is H. pylori. Reducing the burden and cost of dyspepsia will require lifestyle modification and not merely H. pylori eradication.

Adult↗
PubMed1999

Associations of blood rheology and interleukin-6 with cardiovascular risk factors and prevalent cardiovascular disease.

Haemorheological variables (whole-blood, plasma and relative blood viscosity, haematocrit, red cell aggregation, white cell count and fibrinogen) were measured in 753 men and 821 women aged 25-74 years, and related to cardiovascular risk factors and prevalent cardiovascular disease (CVD). Men had higher levels than women of blood viscosity, haematocrit, corrected viscosity and relative viscosity. Post-menopausal women had higher levels than pre-menopausal women of blood viscosity, haematocrit, corrected blood viscosity, plasma viscosity and fibrinogen: each of these differences was completely or partly abolished by use of hormone replacement therapy. Serum total cholesterol, triglycerides, diastolic blood pressure, body mass index and smoking markers showed positive associations with most rheological variables, whereas HDL-cholesterol, plasma vitamin C and social class showed inverse associations. Rheological variables were associated with prevalent CVD after age-adjustment. However, after multiple risk factor adjustment only plasma viscosity and red cell aggregation showed significant (P<0.04) associations in both men and women (comparing top to bottom quarters). Plasma interleukin-6 (measured in a 25% subsample of 196 men and 221 women) correlated significantly with age, fibrinogen, white cell count, plasma and blood viscosity, current smoking, and (in men) with low serum vitamin C levels; but not with other major risk factors or with prevalent cardiovascular disease.

Adult↗
PubMed1999

Coffee and tea consumption in the Scottish Heart Health Study follow up: conflicting relations with coronary risk factors, coronary disease, and all cause mortality.

STUDY OBJECTIVE: To relate habitual (cups per day) tea and coffee consumption to conventional coronary risk factors and subsequent risk of coronary heart disease and death. DESIGN: Cohort study. SETTING: Nationwide random population study. PARTICIPANTS: Over 11,000 men and women aged 40-59 who took part in the Scottish Heart Health Study lifestyle and risk factor survey in 1984-87. Participants were followed up to the end of 1993, an average of 7.7 years, for all cause mortality, coronary death, or any major coronary event (death, non-fatal infarction or coronary artery surgery). Cox's proportional hazards regression model was used to estimate the hazard in consumers of tea and coffee relative to the zero consumption group, both before and after correction for other factors. MAIN RESULTS: Coffee and tea consumption showed a strong inverse relation. For many conventional risk factors, coffee showed a weak, but beneficial, gradient with increasing consumption, whereas increasing tea consumption showed the reverse. Increasing coffee consumption was associated with beneficial effects for mortality and coronary morbidity, whereas tea showed the opposite. Adjusting for age and social class had some effect in reducing associations. Multiple adjustment for other risk factors removed the associations for tea and most of those for coffee although there was a residual benefit of coffee consumption in avoiding heart disease among men. CONCLUSIONS: The epidemiological differences shown in this study occurred despite the pharmacological similarities between tea and coffee. Either they differ more than is realised, or they identify contrasting associated lifestyle and health risks, for which this multiple adjustment was inadequate.

Adult↗
PubMed1999

Planning to meet the needs of offenders with mental disorders in the United Kingdom.

During the last decade the planning of services for offenders with mental disorders in the United Kingdom has been geared toward diverting them from the criminal justice system to appropriate levels of psychiatric and social care. Although a seamless service system is yet to be developed, the central government has made a concerted effort to promote a better understanding of the needs of offenders with mental disorders and encourage collaboration between the relevant agencies. A major program of research has been initiated, and local health authorities have been encouraged to use a consortium approach to planning and delivery of specialist services. The authors discuss the activities of the Wessex consortium, composed of five local health authorities and a social services department serving a catchment area with a population of 2.5 million in southern England. The consortium has commissioned needs assessments for all offenders with mental illness from the catchment area and a survey of the resources for secure residential treatment in the region. Based on data from this research, the consortium is planning the development of two long-stay secure units to accommodate offenders with a history of repeated inpatient and prison stays and poor response to previous treatment and rehabilitation efforts.

Commitment of Persons with Psychiatric Disorders↗
PubMed1999

Activated protein C resistance and the FV:R506Q mutation in a random population sample--associations with cardiovascular risk factors and coagulation variables.

Activated protein C (APC) resistance, defined as a low APC ratio, is associated with the factor V mutation R506Q (factor V Leiden). APC ratio may also be influenced by other clinical and coagulation variables, which we studied in 460 men and 495 women aged 25-74 years, from a random population sample (Glasgow MONICA Survey). APC ratio correlated positively with APTT; and inversely with factor VIIIc, factor IXc, antithrombin activity, prothrombin F1+2 fragment, and thrombin-antithrombin complexes; but not with other coagulation variables. APC ratio decreased with age, but APTT did not. APC ratio and APTT were significantly lower in women versus men, and were significantly lower in users of oral contraceptives or hormone replacement therapy. The FV:R506Q mutation (prevalence 2.5%) was associated with lower APC ratio and protein C and S activities and with higher factor VIIIc levels; but not with increases in F1+2 fragment or thrombin-antithrombin complexes. APC ratio correlated inversely with total cholesterol and diastolic blood pressure; and in women with triglycerides, systolic blood pressure, and body mass index. Obesity was associated with a significantly lower APC ratio. In contrast, smoking markers correlated positively with APC ratio in men. These associations of APC ratio may be relevant to the increased risks of venous thrombosis with age, female sex, oestrogen use, obesity and high factor VIIIc levels. The association of APC resistance with elevated plasma levels of coagulation markers suggests that this phenotype represents an in vivo hypercoagulable state.

Activated Protein C Resistance↗