Biomedical subjects
L Woolf
Publications and source records attributed to L Woolf.
Giving advice on sex... and safety.
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'Coffee & condoms': the implementation of a sexual health programme in acute psychiatry in an inner city area.
A sexual health programme was set up specifically to target mentally ill individuals, providing a distinct group of interventions designed to assist this specialist cohort in acquiring knowledge, skills, and attitudes that will directly contribute to their mental health. The programme consisted of gender-specific and mixed groups, a drop-in service, condom provision and a full-time programme coordinator. Areas covered were safer-sex, knowledge of HIV/AIDS and other sexually transmitted diseases, assertiveness and practical skills of condom use. Mental health nurses possessed the skills to offer sexual health advice to mentally ill individuals. Mentally ill individuals were enthusiastic to attend groups, and were able to participate in the programme.
AIDS prevention programmes at the workplace.
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An international and interregional comparison of haemostatic variables in the study of ischaemic heart disease. Report of a working group.
Levels of haemostatic variables that may be involved in thrombogenesis have been compared in groups of men of similar mean age in communities at very low (Gambia), high (England and Czechoslovakia) or very high (Scotland and Finland) risk of ischaemic heart disease (IHD). There was a consistent gradient of higher factor VII levels with higher IHD risk and also suggestive gradients in the case of two other vitamin K dependent factors, factors II and X. Mean platelet counts were lower and mean fibrinolytic activity was greater in Gambian men than in European men. There was a suggestive though not entirely consistent association between mean fibrinogen levels and IHD risk in the groups from IHD-endemic countries. The results as a whole, and particularly those on factor VII, strengthen the case for the increasingly detailed epidemiological as well as laboratory investigation of the role of the haemostatic system in thrombogenesis and IHD.
Haemostasis in normal pregnancy.
A study has been undertaken in 72 women to provide systematic information on the changes that occur in a wide range of haemostatic variables during and after pregnancy. Factors VII, VIII:C, VIIIR:Ag, X, fibrinogen and alpha 1-antitrypsin, rose markedly throughout pregnancy. Factors II and V and alpha 2 macroglobulin all rose early on but then decreased steadily. Antithrombin III:C and Ag fell slightly. There was a marked decrease in fibrinolytic activity from 11-15 weeks onwards. Levels of fibrin degradation products rose from 21-25 weeks onwards. The rise in coagulation factors that occurs could be due to increased synthesis or increased activation by thrombin, or to both. The findings are consistent with a mild degree of local intravascular coagulation from early on in pregnancy in some women.
Factor VIII in pregnancy and birthweight.
Blood samples taken at 28 and 34 weeks of pregnancy from 495 women were assayed for factor VIII clotting activity (VIIIC) and factor VIII related antigen (VIIIR) to examine the distribution of these factors and to determine whether there was any relationship with birthweight. There was a small positive relationship of little clinical value between factor VIIIR and birthweight only when birthweight was adjusted for gestational age, sex of infant and parity. In pregnancies resulting in a male infant the level of factor VIIIC was lower at 34 weeks gestation than in pregnancies resulting in a female infant. A greater rise in the ratio of VIIIR/VIIIC was observed in women who had any type of hypertension when compared with normotensive pregnancies, but this was not associated with lower birthweight. Both factors VIIIR and VIIIC at 28 weeks gestation were lower for multiparous than for primiparous women, and were lower for those with eventual greater gestation at birth. Asian women had higher mean factor VIIIC than Caucasian women, a finding independent of the fact that women with blood group O had lower mean levels of factors VIIIR and VIIIC than women of other blood groups.
Management of planned pregnancy in a patient with congenital antithrombin III deficiency.
Long-term warfarin therapy was changed to subcutaneous heparin to cover a planned pregnancy in a patient with congenital antithrombin III (AT III) deficiency. Satisfactory anticoagulation was easily maintained in spite of low levels of biologically active AT III. Delivery and the puerperium were covered by a reduced dose of heparin and alternate day infusions of AT III concentrate. A mean dose of 0.77 U/kg of AT III concentrate produced a rise of 1% in AT III and the half-life was of the order of 24 h, with no evidence of increased consumption during labour and delivery. Pregnancy and labour were uncomplicated and resulted in delivery of a healthy female infant. The importance of early and adequate anticoagulation during pregnancy is emphasized.
Hypertriglyceridaemia and hypercoagulability.
18 patients with severe hypertriglyceridaemia (mean fasting plasma triglyceride 5.7 mmol/l) had significantly higher concentrations of plasma fibrinogen and clotting factor Xc than did a normolipidaemic comparison group. Fibrinolytic activity was significantly lower in the hyperlipidaemic patients. Six months of treatment (diet or diet and clofibrate) lowered the patients mean plasma triglyceride to 3.1 mmol/l and caused a fall of clotting factors VIIc and Xc and a significant rise in fibrinolytic activity. None of these variables changed in the comparison group. Raised fibrinogen and factor VIIc concentrations are risk factors for cardiovascular mortality, and raised factor Xc and lowered fibrinolytic activity have both been found in groups at high risk of ischaemic heart-disease. Despite the fact that in population studies triglycerides do not consistently appear to be an independent risk factor for ischaemic heart disease, these data suggest that a pronounced increase in triglycerides warrants energetic therapy because it may be associated with a "hypercoagulable state".
Effect of high-fibre diet on haemostatic variables in diabetes.
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