Biomedical subjects

M Woodward

Publications and source records attributed to M Woodward.

At least 73 records · Page 4Linked to original sources

PubMed1999

Insomnia in the elderly.

BACKGROUND: Insomnia is more common in older people. There are multiple causes of insomnia including medical and psychiatric illness, medications, specific sleep disorders, environmental and behavioural factors and age-related changes in sleep quality and sleep patterns. OBJECTIVE: This article reviews the causes of insomnia, assessment issues and management approaches, to provide the reader with a practical approach to the problem. A comprehensive assessment often reveals reversible factors. Non pharmacological approaches include sleep hygiene measures, increasing sunlight exposure and acupuncture. Only after use of these approaches should short term hypnosedative treatment be commenced. DISCUSSION: With appropriate management, most older people with insomnia will experience improved sleep.

Aged↗

PubMed1999

The epidemiology of mentally disordered offending: a systematic review of studies, based in the general population, of criminality combined with psychiatric illness.

BACKGROUND: The international literature, from 1990 onwards, on the epidemiology of mentally disordered offending (MDO) was systematically reviewed. Studies based solely in the general population are reported in this article. METHODS: Database searches were made back to 1990, followed by citation tracing with the authors or major publications. RESULTS: Two cross-sectional surveys and seven cohort studies were found that have given rise to epidemiological data about MDO in the general population. The most useful data come from cohort studies in Scandinavia. In Scandinavia, the prevalence of MDO up to age 26-30 years is 2.1-2.8 per 100 for men and about half this amount for women. Conduct problems in childhood and deprivation seem to be predictors of future MDO. Mental disorder is associated with acts of crime, most particularly acts of a violent nature. CONCLUSIONS: No systematic epidemiological study of MDO in its own right was found. Those studies which provide data on MDO generally make poor use of statistical methodology. Professional epidemiological and statistical input is required to fully exploit existing data and adequately plan future studies of MDO.

Adolescent↗

PubMed1999

Prescribed drugs: a major cause of ill health.

Explore the source record for details and available documents.

Aged↗

PubMed1999

Self-reported smoking, cigarette yields and inhalation biochemistry related to the incidence of coronary heart disease: results from the Scottish Heart Health Study.

BACKGROUND: Smoking is a well-known risk factor for coronary heart disease (CHD). The components of tobacco that cause CHD have not yet been established; nor have the relative dangers of cigarettes of different strengths. METHODS: This is a cohort study of 2,849 men and 2,900 women with no symptoms of CHD at baseline in the Scottish Heart Health Study. RESULTS: In a 7.7 year follow-up, to 1993, there were 123 male and 49 female CHD events. After adjusting for age, cholesterol and blood pressure, men who smoke > or = 20 cigarettes per day have a relative hazard [95% confidence interval (CI)] of 1.93 (1.15-3.24) compared with non-smokers; for women the corresponding relative hazard is 3.81 (2.00-7.27). Biochemical measures (cotinine, thiocyanate and expired-air CO) are closely correlated with self-reported smoking (0.67 < or = r < or = 0.72), and have similar relationships with CHD. Amongst cigarette smokers, relative hazards (third to first tertile), for tar yield are 1.05 (0.54-2.07) for men and 4.00 (1.13-14.18) for women. Nicotine and CO yields give similar results. Hazard ratios associated with heavy smoking and strong cigarettes are thus much higher for women. CONCLUSION: Although smoking was found to have a detrimental effect, this study was unable to suggest a single major cause of CHD. The excess effects found in women compared with men could be due to differences in former smoking habits. Furthermore, risk differences for smoking are slightly greater for men, explained by the relatively low incidence of CHD amongst women.

Adult↗

PubMed1998

Effects of interleukin-1 receptor antagonist in a slow-release hylan vehicle on rat type II collagen arthritis.

PURPOSE: To determine the effect of hylan fluid (HA), a model slow release vehicle on the pharmacokinetic profile and efficacy of interleukin-1 receptor antagonist (IL-1ra) in rats with established type II collagen arthritis. METHODS: Female Lewis rats with type II collagen arthritis were treated daily, every other day or every third day with single subcutaneous (sc) injections of IL-1ra formulated in HA and the effects on arthritis determined. Results were compared to those obtained with IL-1ra in citrate buffered saline with EDTA and polysorbate (CSEP). Sequential blood levels were determined in rats injected sc with IL-1ra in CSEP or HA. RESULTS: Incorporation into HA led to slower release of IL-1ra into the bloodstream and maintained therapeutic blood levels of IL-1ra for a longer time compared to the IL-1ra/CSEP formulation. Single daily sc doses of 100 mg/kg IL-1ra in CSEP were ineffective in type II collagen arthritis. By contrast, once per day dosing of 100 mg/kg IL-1ra in HA provided 78% inhibition of paw swelling. Every other day dosing with 100 mg/kg IL-1ra in HA resulted in 62% inhibition. IL-1ra (100 mg/ kg in HA) given every third day provided 19% inhibition of arthritis. Improved efficacy correlated with improved pharmacokinetics. CONCLUSIONS: Administration of IL-1ra in the slow release vehicle HA improves pharmacokinetics and efficacy in rat type II collagen arthritis.

Animals↗

PubMed1998

Fibrinogen as a risk factor for coronary heart disease and mortality in middle-aged men and women. The Scottish Heart Health Study.

AIMS: Fibrinogen was measured in 5095 men and 4860 men aged 40-59 in a random population sample from 25 districts of Scotland recruited during 1984-87: the Scottish Heart Health Study. Fibrinogen was then related to the chance of fatal and non-fatal coronary events and death from any cause during a subsequent follow-up period of around 8 years. METHODS AND RESULTS: Fibrinogen was measured by the Clauss assay. The effect of fibrinogen on coronary heart disease and death was assessed through age-adjusted means and Cox proportional hazards regression models, accounting for age, cotinine (a measure of tobacco smoke inhalation) and 11 other major coronary risk factors. Fibrinogen was found to be an important risk factor for coronary heart disease in men and women, with and without pre-existing coronary heart disease. There appears to be a threshold effect, with those in the highest fifth of the distribution having a much increased risk. Estimated age-adjusted hazard ratios by sex and pre-existing coronary heart disease group for the highest to lowest fifth of fibrinogen range between 1.93 and 4.86. Fibrinogen is also important as a risk factor for coronary death and all-causes mortality, with a similar threshold effect. Comparing the two extreme fifths, the hazard ratios for coronary death are 3.01 and 3.42, and for all-cause mortality are 2.59 and 2.20, for men and women respectively. Adjustment for cotinine reduces the hazard ratios, but further adjustment for the other 11 risk factors has little effect for coronary heart disease events. After full adjustment there is a remaining significant (P < 0.05) hazard ratio for coronary death and death from any cause and for a coronary heart disease event for those free of coronary heart disease at baseline, amongst men, comparing the highest to the lowest fifth. CONCLUSION: Fibrinogen is a strong predictor of coronary heart disease, fatal or non-fatal, new or recurrent, and of death from an unspecified cause, for both men and women. Its effect is only partially attributable to other coronary risk factors, the most important of which is smoking.

Adult↗

PubMed1997

Comparison of the prediction by 27 different factors of coronary heart disease and death in men and women of the Scottish Heart Health Study: cohort study.

OBJECTIVE: To compare prediction by 27 different factors in men and women of coronary heart disease events, coronary deaths, and deaths from all causes. DESIGN: Cohort study. SETTING: Scottish population study. SUBJECTS: In 1984-7 random sampling of residents aged 40-59 produced 11,629 men and women who generated survey clinic questionnaires, examination findings, and blood and urine specimens. MAIN OUTCOME MEASURES: Subsequent death, coronary artery surgery, and myocardial infarction. Risks were calculated for each category of factor or fifth of continuous variables. 27 factors were ranked by descending age adjusted hazard ratio of the top to bottom class in each factor, by sex and end point. RESULTS: Follow up averaged 7.6 years, during which the 5754 men had 404 coronary events, 159 coronary deaths, and 383 deaths and the 5875 women 177, 47, and 208 respectively. The rankings for factors for the three end points were mainly similar in men and women, although hazard ratios were often higher in women. Classical risk factors ranked better for predicting coronary risk than newer ones. Yet strong prediction of coronary risk was no guarantee of significant prediction of all cause mortality. Findings included an anomalous coronary protective role for type A behaviour in women; raised plasma fibrinogen as a strong predictor of all end points; and an unexpectedly powerful protective relation of dietary potassium to all cause mortality. CONCLUSIONS: These initial unifactorial rankings and comparisons must be interpreted with caution until potential interaction, confounding, and problems of measurement and causation are further explored.

Adult↗

PubMed1997

Oral contraceptives and venous thromboembolism.

Explore the source record for details and available documents.

Adult↗

PubMed1997

Sequence heterogeneity of an mpb70 gene analogue in Mycobacterium kansasii.

The protein antigen MPB70 is a major component of culture supernatants of Mycobacterium bovis and is an active ingredient of bovine PPD used for skin-testing cattle for tuberculosis. We have shown that Mycobacterium kansasii possesses a similar gene that cross-reacts in a PCR test for M. bovis. Single strand conformational polymorphism analysis, and the DNA sequence of the PCR product, shows differences between M. kansasii strains, supporting the suggestion that M. kansasii is not a homogeneous species.

Animals↗

PubMed1997

Effect of socioeconomic group on incidence of, management of, and survival after myocardial infarction and coronary death: analysis of community coronary event register.

OBJECTIVE: To investigate the effect of socioeconomic group (with reference to age and sex) on the rate of, course of, and survival after coronary events. DESIGN: Community coronary event register from 1985 to 1991. SETTING: City of Glasgow north of the River Clyde, population 196,000. SUBJECTS: 3991 men and 1551 women aged 25-64 years on the Glasgow MONICA coronary event register with definite or fatal possible or unclassifiable events according to the criteria of the World Health Organisation's MONICA project (monitoring trends and determinants in cardiovascular disease). MAIN OUTCOME MEASURES: Rate of coronary events; proportion of subjects reaching hospital alive; case fatality in admitted patients and in community overall. RESULTS: Event rates increased with age for both sexes and were greater in men than women at all ages. The rate increased 1.7-fold in men and 2.4-fold in women from the least (Q1) to the most (Q4) deprived socioeconomic quarter. The socioeconomic gradient decreased with age and was steeper for women than men. The proportion treated in hospital (66%) decreased with age, was greater in women than men, and decreased in both sexes with increasing deprivation (age standardised odds ratio 0.82 for Q4 v Q1) Case fatality in hospital (20%) increased with age, was greater for women than men when age was standardised, and showed no strong socioeconomic pattern. Overall case fatality in the community (50%) increased with age, was similar between the sexes, and increased from Q1 to Q4 (age standardised odds ratio 1.12 in men, 1.18 in women). CONCLUSIONS: Socioeconomic group affects not only death rates from myocardial infarction but also event rates and chance of admission. This should be taken into account when different groups of patients are compared. Because social deprivation is associated with so many more deaths outside hospital, primary and secondary prevention are more likely than acute hospital care to reduce the socioeconomic variation in mortality.

Adult↗

PubMed1997

Evidence for age-related differences in the fatty acid composition of human adipose tissue, independent of diet.

OBJECTIVE: To test the null-hypothesis that no age difference in adipose tissue fatty acid composition exists independent of dietary fat intake. DESIGN: A cross-sectional survey of coronary heart disease risk factors, the Scottish Heart Health Study, provided needle biopsy adipose tissue fatty acid data and food frequency-derived dietary data. SETTING: Twenty-two Scottish Districts between 1984 and 1986. SUBJECTS: A total of 10,359 men and women aged 40-59 y were randomly recruited in sex and five-year age bands from GP lists. A sub-set of 2308 men and 2049 women (42%) provided satisfactory adipose tissue and dietary data. MAIN OUTCOME AND MEASURES: Multiple regression analysis (adjusting for dietary fats, body mass index and smoking, with and without menopause status for women) of the relationship between individual fatty acids in adipose tissue and age, and between age and the ratio of linoleic acid (C18:2, n-6) to gamma-linolenic acid (C18:3, n-6) as an indicator of delta-6 desaturase activity. RESULTS: Sex-consistent changes with age occurred for linoleate (adjusted regression slope +/- s.e. for men -0.299 +/- 0.1339 and for women -0.504 +/- 0.1731) and gamma-linolenate (adjusted regression slope +/- s.e. for men -0.141 +/- 0.0341 and for women -0.154 +/- 0.0469) both P < 0.0001. These changes gave rise to a significant increase (P < or = 0.005) in the C18:2, n-6 to C18:3, n-6 ratio with age). Dihomo-gamma-linolenic acid (C20:3, n-6) and docosahexa- plus docosapentaenoic acids (C22:5 + C22:6, n-3) also increased significantly with age (P < or = 0.01). For the latter, the adjusted regression slopes were far greater for women (0.596 +/- 0.0575) than men (0.131 +/- 0.0417). CONCLUSIONS: The results show that ageing does influence adipose tissue fatty acid composition independent of diet. The sex differences may partially be due to inadequate adjustment for changes in sex hormone status in males with ageing. Using the current indicator, a decline in the rate limiting step of beta-6 desaturation appeared to occur with age, and was greater in women than in men. These results may indicate that an increase in dietary gamma-linolenic acid (C18:3, n-6) is necessary with age to offset the relative imbalance between PUFA levels which appears to occur. However, any direct health benefit regarding the common diseases of ageing from such a strategy still remain to be clarified.

8,11,14-Eicosatrienoic Acid↗

PubMed1997

Moderate weight reduction improves red cell aggregation and factor VII activity in overweight subjects.

OBJECTIVE: To investigate the effect of a dietary intervention to reduce body weight on red cell aggregation (RCA), factor VII activity, plasminogen activator inhibitor (PAI) activity, tissue plasminogen activator (t-PA) antigen, fibrinogen, whole blood and plasma viscosity, haematocrit and lipids. DESIGN: Open single stranded study of dietary intervention for weight loss in a volunteer sample. SUBJECTS: Forty-five subjects whose BMI exceeded 26 kg/m2 were recruited and received dietetic advice designed to reduce body weight by 0.5 kg per week. MEASUREMENTS: Body weight and waist and hip circumferences, dietary intake by seven day weighed inventory, RCA, factor VII activity, PAI activity, t-PA antigen, fibrinogen, whole blood and plasma viscosity, haematocrit and lipids. RESULTS: After 12 weeks of dietary intervention there were reductions in body weight and BMI by 5.9 (s.d. 3.3) kg and 1.9 (s.d. 1.0) kg/m2 respectively in males, and 4.1 (s.d. 2.9) kg and 1.6 (s.d. 1.1) kg/m2 in females (P < 0.0001). Factor VII activity (P = 0.0043), RCA (P = 0.01) and t-PA antigen (P = 0.016) were reduced in females after weight reduction but no differences were found in PAI activity, whole blood, plasma viscosity or haematocrit. The changes in factor VII activity and RCA were appropriate for the changes in BMI on the basis of the relationships of the risk factors with BMI in a cross sectional survey of a representative Scottish population. Plasma total cholesterol was reduced (P = 0.016) but HDL cholesterol and triglycerides remained unchanged. There were significant associations between the reductions in factor VII activity and BMI (r = 0.395, P = 0.013) and between the reductions in RCA and waist to hip ratio (r = 0.350, P = 0.04). No relationship was seen between changes in serum cholesterol and changes in factor VII activity or RCA. CONCLUSIONS: Modest weight loss, of 5% body weight, with conventional dietary intervention reduces two established risk factors for ischaemic heart disease (factor VII activity and RCA) which are generally elevated in those with increased body weight.

Adult↗

PubMed1997

Epidemiology of coagulation factors, inhibitors and activation markers: the Third Glasgow MONICA Survey. I. Illustrative reference ranges by age, sex and hormone use.

Adult↗

PubMed1997

Epidemiology of coagulation factors, inhibitors and activation markers: The Third Glasgow MONICA Survey. II. Relationships to cardiovascular risk factors and prevalent cardiovascular disease.

Coagulation factor activity (fibrinogen, VII, VIII and IX), coagulation inhibitor activity (antithrombin, protein C, protein S), and coagulation activation markers (prothrombin fragment F1, 2; thrombin-antithrombin complexes) were measured in 746 men and 816 women aged 25-74 years, randomly sampled from the north Glasgow population in the Third MONICA Survey. After age-adjustment, significant associations with cardiovascular risk factors were observed. Serum cholesterol and triglyceride were associated with increases in factors VII and IX, as well as antithrombin, protein C and protein S; and with increased fibrinogen and factor VIII in women. Apart from factor VIII (related to blood pressure in men, but not in women), similar associations were observed for blood pressure and body mass index. Smoking status and/or smoking markers were related to fibrinogen, factor IX, antithrombin and protein S. Alcohol intake was related to protein S, and inversely to fibrinogen and antithrombin in men. Low social class was associated with fibrinogen, factor VIII, factor IX, and with antithrombin, protein S, and low protein C in men. Serum vitamin C was associated inversely with coagulation factors and coagulation inhibitors. The only associations of activation markers were with low serum vitamin C, and with alcohol consumption and low social class in men. Prevalent cardiovascular disease was associated only with fibrinogen. These associations of coagulation factors and inhibitors with cardiovascular risk factors are plausibly relevant to thrombotic risk in cardiovascular disease. In general, 'worse' values of risk factors are associated with increased plasma levels of both coagulation factors and inhibitors, without significant increase in coagulation activation markers. However, the association of lower serum vitamin C with increased coagulation activation markers is of potential therapeutic interest.

Adult↗

PubMed1997

Helicobacter pylori infection and coronary heart disease in the North Glasgow MONICA population.

AIM: Recent evidence suggests that Helicobacter pylori infection is associated with coronary heart disease. We investigated whether H. Pylori infection is related to prevalent coronary heart disease, in a random sample of 1428 men and women aged 25-74 years. METHODS AND RESULTS: Coronary heart disease was assessed by questionnaire and electrocardiography (ECG). Standard risk factors for coronary heart disease, fibrinogen concentration and serum concentrations of H. pylori-specific IgG antibody were measured. H. pylori seropositivity increased with age (P < or = 0.001) and was significantly more prevalent in men than women. H. pylori infection was associated with current smoking and a higher systolic blood pressure in men but not in women. There was no significant increase in the odds ratio in those seropositive for H. pylori with regard to any manifestation of coronary heart disease, after adjustment for age, standard cardiovascular risk factors and social class. Likewise, age-adjusted plasma fibrinogen was no higher in seropositives. CONCLUSION: Seropositivity to H. pylori is associated with a trend towards a greater prevalence of coronary heart disease. However, that association is likely to be spurious and can be adequately explained by the much stronger association of H. pylori infection with age and social class, both of which are linked with coronary heart disease.

Adult↗

PubMed1996

Sex differences in myocardial infarction and coronary deaths in the Scottish MONICA population of Glasgow 1985 to 1991. Presentation, diagnosis, treatment, and 28-day case fatality of 3991 events in men and 1551 events in women.

BACKGROUND: Scottish MONICA used medical and medico-legal records and World Health Organization MONICA Project criteria to register coronary events in 25- to 64-year-old residents of the high-incidence area of north Glasgow from 1985 to 1991. METHODS AND RESULTS: Age-standardized data from 3991 episodes of nonfatal definite myocardial infarction and coronary deaths in men (mean age, 55.5 years) were compared with 1551 in women (57.0 years). Many results, such as the overall 28-day fatality rates of 49.8% in men and 48.5% in women, showed insignificant differences. However, 74.3% of deaths in men occurred out of hospital versus 67.8% in women (P = .0004). After admission to hospital, fatality rates in women were 14% higher (P = .07) and after admission to coronary care, 22% higher (P = .04). Women were more often widowed. Fewer had a history of previous myocardial infarction, but the prevalence of angina pectoris, of smoking, and of chest pain in the attack was the same as in men; more had shock, syncope, and breathlessness. More consulted a doctor before admission to hospital, which delayed their coming under care. More men had ECG Q-wave progression, and more women had smaller ECG changes. This, and marginally reduced chances of direct admission to coronary care, of thrombolysis, of aspirin, and of beta-blockers, did not explain women's excess hospital fatality. CONCLUSIONS: Acute coronary events appear to be recognized and treated fairly equally in men and women 25 to 64 years old in Glasgow, so differences are small but subtle. More men die suddenly out of hospital; the reason why more women die after arrival may be because the equivalent number of men have already died outside.

Acute Disease↗

PubMed1996

Does dietary trans fatty acid intake relate to the prevalence of coronary heart disease in Scotland?

Reports of the effects of trans fatty acids on coronary heart disease are inconsistent. Trans fatty acids may particularly influence coronary risk when linoleic acid levels are low, a situation which occurs in Scotland where prevalence of coronary heart disease is also very high. The link between trans fatty acid intake and prevalent coronary heart disease was therefore investigated in the Scottish Heart Health Study population. Trans fatty acid intakes were calculated from 10/359 sets of food-frequency questionnaire data obtained from the cross-sectional survey of men and women aged 40-59 years. Logistic regression analysis was used to calculate the odds ratios for prevalent coronary heart disease by fifths of dietary intake of total, natural and commercial hydrogenation-derived trans fatty acid. The group who had undiagnosed coronary heart disease at the time of survey was the pertinent group for examining the possible causative effects of trans fatty acid intake. After adjustment for the confounding factors (i.e. age, weight, height, smoking, level of physical activity, blood pressure, total energy intake and intakes of saturated fat, linoleic acid and the antioxidant vitamins) the odds of undiagnosed coronary heart disease for men, relative to the lowest intake fifth, did not differ significantly from unity by total or commercially-derived trans fatty acid intake. Odds were around 35% smaller in the higher intake fifths of naturally-derived trans fatty acids. For women, the odds of undiagnosed coronary heart disease tended to be greater in the higher fifths of total (odds ratio 1.36 (95% confidence interval 0.94, 1.89)) and hydrogenated (1.26 (0.92, 1.72)) trans fatty acid relative to the lowest fifth, but only reached significance in the third fifth of total trans fatty acid (1.36 (1.01, 1.83)). Dietary total and commercially-derived trans fatty acids failed to influence the odds of coronary heart disease for men, even though a significant increase in the ratio of low density plus very low density lipoprotein to high density lipoprotein-cholesterol occurred with trans fatty acid intake. The results, therefore, do not support a major effect of dietary trans fatty acid from commercial hydrogenation on coronary heart disease risk in these Scottish men. The results for women are less clear, and the possibility remains that individuals at the high extreme of trans fatty acid intake, who may be essential fatty acid deficient, are at enhanced risk of coronary heart disease.

Adult↗

PubMed1996

Small area statistics as markers for personal social status in the Scottish heart health study.

OBJECTIVE: To evaluate a deprivation index, calculated from small area statistics for postcode sectors, as a measure of individual social status in an epidemiological study of coronary heart disease (CHD). DESIGN: A baseline, cross sectional survey. SETTING: Twenty two local authority districts of Scotland surveyed between 1984 and 1986. SUBJECTS: A total of 10359 men and women aged 40-59 years randomly selected to the Scottish heart health study. MAIN RESULTS: The Scottish deprivation categorisation, derived from small area statistics, exhibits a strong linear trend (p = 0.001 or below) for individual prevalent CHD for men and women, unadjusted, and adjusted for major cardiovascular risk factors. The degree of association with CHD is similar to that for measures of social class based upon occupation. CONCLUSIONS: The Scottish deprivation categorisation is an effective measure of individual social status in the current study, broadly comparable in its effect with the more traditional classification derived from occupations. The latter has important problems in definition, especially for women. Small area statistics may provide a useful marker of individual social status in a more general epidemiological setting.

Adult↗