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Biomedical subjects

M Woodward

Publications and source records attributed to M Woodward.

At least 19 recordsLinked to original sources
PubMed1992

An iterative technique for identifying smoking deceivers with application to the Scottish Heart Health Study.

BACKGROUND: The study population consists of 3,977 self-declared nonsmokers for whom complete data on smoking biochemistry were available. Data were obtained from the Scottish Heart Health Study, a random cross-sectional population sample of 40- to 59-year-old men and women. METHODS: Three biochemical markers of smoking (expired-air carbon monoxide, serum thiocyanate, and serum cotinine) are used together to derive optimum cut-points for distinguishing true nonsmokers from self-declared nonsmokers who are smoking deceivers, using an iterative procedure via a computer program. RESULTS: The cut-points derived are, for carbon monoxide, 6 ppm (sensitivity, 0.81, and specificity, 0.94, when compared with the other two biochemical markers combined), for thiocyanate, 63.4 mumol/liter (sensitivity, 0.75; specificity, 0.92), and, for cotinine, 17.5 ng/ml (sensitivity, 0.77; specificity, 0.98). These cut-points are generally lower than those reported previously, primarily because other studies have taken self-reported smoking status to be the truth. The presence of deceivers among declared nonsmokers would tend to raise the biochemical levels of this group and hence of the cut-points. CONCLUSION: The prevalence of smoking deception in the Scottish population is low: the frequency of those at or above all three cut-points is 1.2%, at or above two or more (the preferred definition of a smoking deceiver) is 2.2%, and at or above at least one is 16.4%.

Adult↗
PubMed1992

Social status and coronary heart disease: results from the Scottish Heart Health Study.

Social status has frequently been found to be associated with the prevalence of coronary heart disease. Currently, in developed countries, it seems that the least advantaged social groups are at the greatest risk. This article addresses this issue in the Scottish population, using a cross-sectional sample of 10,359 men and women. Four measures of social status are used: level of education, years of education, housing tenure, and the Office of Population Censuses and Surveys' definition of social class based on occupation. By each of these four criteria, and for both sexes, the least advantaged have a significantly higher coronary heart disease prevalence (P less than 0.01). The odds ratios for housing tenure are highest, being 1.63 and 1.55 for men and women, respectively, comparing those who live in rented accommodation with owner-occupiers. After adjustment for a number of coronary heart disease risk factors, which are possible confounding variables, most, if not all, of the significant effect of education and occupation on coronary heart disease is removed. Housing tenure is still highly significant (P less than 0.001), with odds ratios of 1.48 and 1.45 for men and women, respectively. Smoking and fibrinogen are the most important confounding variables for men, and body mass index, high-density lipoprotein cholesterol, and triglyceride levels, the most important for women. When relationships among the social factors themselves are investigated, housing tenure is found to remove the significant effects of education and occupation in men, and of education in women. No other social factor removes the significant effect of housing tenure (P less than 0.001). Housing tenure in Scotland is thus found to be the most discriminatory measure of social status in relation to coronary heart disease.

Adult↗
PubMed1992

Biochemical evidence of persistent heavy smoking after a coronary diagnosis despite self-reported reduction: analysis from the Scottish Heart Health Study.

Data from 9740 Scottish men and women aged 40-59 years, selected at random in a population survey during 1984-86, were used to compare self-reported smoking habits and biochemical measures of tobacco smoke inhalation in three groups: 625 with diagnosed coronary heart disease; 1497 undiagnosed, but with suggestive questionnaire symptoms or electro-cardiographic signs; and 7618 with no diagnosis or evidence of coronary disease, nor cardiovascular medication. Men and women with a diagnosis of coronary heart disease reported that they had tried to reduce their cigarette consumption or had quit more often than did the two comparison groups, but this effect was considerably greater in men than in women. Men in all groups had a higher cigarette quitting rate, but this may be due to switching to pipes and cigars. However, the biochemical measurement of tobacco smoke inhalation by cotinine showed that those with a coronary diagnosis had the highest overall levels of tobacco smoke inhalation, and the highest level of cotinine per self-reported cigarette, cigar, or ounce (30 g) of pipe tobacco consumed. Self-reporting after a coronary diagnosis is consequently distorted, and an objective measure of smoke inhalation is to be preferred. In both sexes, particularly women, intake of tobacco products remains higher than that in the general population, whether or not it was even higher before they were diagnosed. Those responsible for continuing care of coronary patients need to be aware that health education and compliance are less effective in this group than they should be, both in male patients and, even more so, in women.

Breath Tests↗
PubMed1992

Do smokers of lower tar cigarettes consume lower amounts of smoke components? Results from the Scottish Heart Health Study.

Data on 1133 men and 1621 women who smoke solely cigarettes with a known tar yield are extracted from the baseline population survey of the Scottish Heart Health Study. The expired-air carbon monoxide (CO-E), serum thiocyanate and serum cotinine values are compared between smokers in three tar groups: low (below 13 mg/cig.), middle (14-15 mg/cig.) and high tar (above 15 mg/cig.). An index of tar consumption is calculated assuming that the intake of different smoke components relative to one another is in proportion to their concentration in the smoke. CO-E and cotinine are found to peak in the middle tar group. Thiocyanate only tends to increase from low to middle tar group for women and from middle to high tar group for men. Tar consumption increases with tar yield of the cigarette smoked, but the increase is much lower than would be expected. We conclude that the tar yield of a cigarette is not an accurate guide to the amount of smoke components consumed by its smoker. Health professionals should be aware of these limitations of tar yield as a measure of cigarette strength.

Attitude to Health↗
PubMed1992

The Scottish Heart Health Study. Dietary intake by food frequency questionnaire and odds ratios for coronary heart disease risk. II. The antioxidant vitamins and fibre.

High serum antioxidant vitamins are increasingly being associated with reduced risk of coronary heart disease (CHD). Previous studies have not addressed the relationship between dietary antioxidant vitamins and risk of CHD although diet is a key factor which modifies blood antioxidant vitamin levels. In prospective studies, high-fibre diets have also been associated with reduced CHD incidence. In this analysis CHD-diagnosed, -undiagnosed and non-CHD controls were selected from 10,359 men and women aged 40-59 who participated in a cross-sectional study of CHD risk factors. Diet was assessed by food frequency questionnaire, odds ratios were adjusted for the classical CHD risk factors (+/- social class) and calculated relative to the first quintile for each vitamin and total fibre. The antioxidant vitamins were further combined in a principal component analysis and the odds ratios for undiagnosed and diagnosed CHD were again calculated. For undiagnosed CHD, risk was significantly lower in the highest quintiles of beta-carotene, fibre and vitamin C, E and A for men, but only lower for fibre in women. Opposite trends were observed in the odds ratios for vitamin C and E and fibre for male-diagnosed CHD which possibly indicates changes in diet as a result of diagnosis. Principal component analysis showed significantly reduced risk of undiagnosed CHD in the top three quintiles for men (odds ratios 0.66, 0.67 and 0.64; P less than 0.05 in each case). A similar trend occurred for women but was non-significant. The results suggest that high dietary intake of the antioxidant vitamins may reduce risk of CHD, particularly in men, and that fibre may be equally cardio-protective in both sexes.

Adult↗
PubMed1992

Variation in coronary risk factors by social status: results from the Scottish Heart Health Study.

The relationship between social status and coronary heart disease in the United Kingdom is well established with the more socially disadvantaged being at higher risk. There is also evidence that the levels of most of the known coronary risk factors vary with social status in a way consistent with their relationship to coronary heart disease. Using data from the Scottish heart health study the aim of this study was to quantify, for men and women, the variation in four of the main coronary heart disease risk factors--smoking, serum total cholesterol level, blood pressure and obesity--according to a number of social factors--occupational social class, housing tenure, level of education and employment status. The analyses used both mean risk factor levels as well as the percentages above suggested cut off levels, in order to provide estimates of the percentage of people at risk. All the risk factors, apart from total cholesterol level in men, showed fairly consistent variation across social groups with the more socially disadvantaged being at higher risk. Similar social variation was found for the percentages above the cut off levels, and these indicate that nearly 60% of the Scottish population aged 40-59 years, have one or more risk factors for coronary heart disease. These results suggest that some targeting of health education and management is appropriate, and this is especially relevant as the reforms to the National Health Service set health targets for health authorities and encourage general practitioners to provide health promotion services.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

The Scottish Heart Health Study. Dietary intake by food frequency questionnaire and odds ratios for coronary heart disease risk. I. The macronutrients.

Identification of the risk of coronary heart disease (CHD) from nutrients in the diet is of importance to both primary and secondary disease prevention. This paper reports the mean intakes and odds ratios for the macronutrients in groups of CHD-diagnosed, -undiagnosed and CHD-free men and women, aged 40-59 years, who participated in the Scottish Heart Health Study (n = 10,359). Diet was assessed by food frequency questionnaire and odds ratios were determined relative to the lowest quintile and adjusted for the classical CHD risk factors (+/- social class). Six per cent of the study population were CHD-diagnosed and 14.5% were identified as possible cases of undiagnosed CHD. The results suggest that change in diet as a result of diagnosis does occur, and is more pronounced in men. The effect is to give odds ratios, for diagnosed CHD, opposite to those which may be expected on the basis of current knowledge of nutrition and CHD risk. According to the intake data from the undiagnosed group, a relatively low energy intake, a high percentage of energy from protein and a moderate percentage of energy from alcohol diet are favourable factors with respect to CHD risk for men. For women, only alcohol significantly altered risk of undiagnosed CHD, and surprisingly, no measure of dietary fat showed a modifying effect on risk of undiagnosed CHD for men or for women. The implications, and influence of measurement error and variance on these results are discussed.

Adult↗
PubMed1991

Smoking characteristics and inhalation biochemistry in the Scottish population.

Data from a cross-sectional random population sample of 10,359 middle-aged Scottish men and women are used to investigate the relationships between self-reported tobacco consumption and three biochemical markers of tobacco inhalation: expired air carbon monoxide (CO), serum thiocyanate and serum cotinine. These data represent one of the largest samples of these biochemical markers yet analysed. The results show that, for each sex, the biochemical markers are highly correlated for smokers and for the entire sample of mixed smokers and non-smokers. CO is the preferred biochemical marker, in such groups, because it is the cheapest, is non-invasive and gives virtually instantaneous results. Self-reported daily cigarette consumption also correlates well with each of these biochemical markers, and so it appears that people are, in the context of population studies, mainly truthful about their smoking. The relationships with self-reported cigarette consumption are curvilinear with apparent levelling out of the gradient at around 25 cigarettes/day for cotinine and thiocyanate and at greater than 40 cigarettes/day for CO. Sex differences are small, although thiocyanate is generally higher and cotinine generally lower in women with the same self-reported cigarette consumption as men. Amongst non-smokers, only cotinine is able to discriminate between self-reported levels of exposure to passive smoking. CO and thiocyanate are not suitable for measuring low levels of smoke inhalation, such as found in passive smokers.

Adult↗
PubMed1991

The drinking, passive smoking, smoking deception and serum cotinine in the Scottish Heart Health Study.

Following a recent claim that the use of cotinine in body fluids, to assess passive smoking and smoking "deception", was confounded by metabolic individuality, and by non-tobacco sources of dietary nicotine, particularly tea, data were examined from a large cross-sectional survey in a tea-drinking population. In 3383 men and women aged 40-59 years from the Scottish Heart Health Study, defined as non-smokers, both by self-report and by low thiocyanate and expired air carbon monoxide levels, serum cotinine showed minimal association with self-reported daily average tea consumption. However, there was a strong correlation between degree of self-reported passive tobacco smoke exposure and median serum cotinine level. In the same survey, serum cotinine in 4144 self-reported non-smokers and in 3326 smokers showed entirely different distributions, but the same range, suggesting heavy nicotine intake in some "non-smokers". These analyses confirm that cotinine levels in true non-smokers reflect far more the nicotine in inhaled ambient tobacco smoke than they do nicotine in tea. Some smoking "deceivers" have the same degree of exposure to nicotine as heavy smokers. Despite individual variability, the claim of confounding is poorly supported, and cotinine is confirmed as an indicator both of passive smoking and of smoking deception.

Adult↗
PubMed1991

Nutrient intakes of different social-class groups: results from the Scottish Heart Health Study (SHHS).

Food frequency questionnaire and socio-demographic data were collected from over 10,000 Scottish men and women aged 40-59 years in a cross-sectional study of coronary heart disease (CHD) risk factors. Dietary intake, including the antioxidant vitamins C and E and beta-carotene, was assessed for different socio-economic groups. Trends in nutrient intakes were found with social-class (occupational) groups I-V. The non-manual-manual distinctions were clear even after standardizing for serum cotinine, and alternative classification by housing tenure and level of education did not confound the social-class effect. Total energy intake was significantly higher in the manual (men 10,363 KJ, women 7507 KJ) than in the non-manual (men 9156 KJ, women 7169 KJ) groups, and all nutrient amounts except for vitamin C, vitamin E, beta-carotene and fibre were significantly higher in the manual than the non-manual groups. Alcohol intake was lower in manual women, but higher in manual men compared with their respective non-manual groups. Sex and social-class differences were maintained after adjusting for total energy. Women in general, and manual women in particular, had the highest percentage energy from total fat (40.2) and saturated fat (18.2), while the percentage energy from polyunsaturated fat was lower in men than women, and lowest in manual men (4.4). The polyunsaturated:saturated fat (P:S) ratios were, for non-manual and manual men 0.32 and 0.31, and for non-manual and manual women 0.31 and 0.28. Fibre and antioxidant vitamin intakes, when expressed as nutrient densities, were lower in men than women, and lowest in manual men. Overall, men and women in manual occupations had a poorer-quality diet than did those in non-manual occupations. The coincident low P:S ratios and low antioxidant vitamin intakes in manual groups may contribute to an increased risk of CHD. Thus, the findings are compatible with the view that poor diet may be a contributory factor to the higher mortality rates for CHD which occur in the lower socio-economic groups.

Adult↗
PubMed1991

Dietary and non-dietary predictors of serum total and HDL-cholesterol in men and women: results from the Scottish Heart Health Study.

UNLABELLED: An analysis of the associations between dietary and non-dietary variables and serum total cholesterol (Total-C) and high density lipoprotein cholesterol (HDL-C) was performed using data from the Scottish Heart Health Study--a cross-sectional survey of men (n = 5123) and women (n = 5236), aged 40-59. Subjects completed a questionnaire which provided health, socio-demographic and food frequency data. Nutrient intakes were calculated from UK food composition tables using standard portion sizes. For men, the significant independent dietary predictors of Total-C, after adjustment for all the other dietary variables, were saturated fat and cereal fibre, and after adjustment for the non-dietary variables, were cereal fibre, saturated fat and cholesterol. For women, intake of vegetable fibre, white fish and beta-carotene were significant independent predictors of Total-C after adjustment for all the other dietary variables. Only beta-carotene remained significant after adjustment for all the non-dietary variables. Alcohol intake and body mass index were respectively the strongest positive and negative predictors of HDL-C for both sexes. IN CONCLUSION: (1) certain dietary factors may affect serum cholesterol levels differently for men and women; (2) a possible role for the antioxidant vitamins and fibre in the prediction of serum cholesterol, may be indicated, in addition to the 'classical' role of dietary cholesterol and saturated fat and (3) confounding between the social and dietary variables does occur, and confirms the need for multiple adjustments in studies of this nature.

Adult↗
PubMed1991

Bias from missing values: sex differences in implication of failed venepuncture for the Scottish Heart Health Study.

Missing values are common in epidemiological data, and yet their possible effect on the results of the investigation is seldom quantified despite the fact that they are a likely source of bias. This paper describes a simple method, based on odds ratios, for assessing whether missing values are likely to cause bias, and for quantifying the magnitude of any such bias. The method is applied to the Scottish Heart Health Study, a study of risk factors for coronary heart disease amongst 10,359 men and women. It is found that, although no bias is apparent in the male subjects, females with missing blood samples are twice as likely to have a history of myocardial infarction than other women. Missing blood samples are shown to be associated with increased body mass index and difficult peripheral veins. The bias caused by the missing female blood samples is considerable, with estimated errors of between 4% and 12% in the mean values of total cholesterol, HDL-cholesterol, triglycerides, creatinine, uric acid and fibrinogen.

Adult↗
PubMed1991

Reduction of testosterone synthesis after high dose interleukin-2 therapy of metastatic cancer.

We have investigated the effect of high dose iv bolus interleukin-2 (IL-2) therapy on sex hormone and adrenal steroid concentrations in six men treated for metastatic renal cell carcinoma or malignant melanoma. Blood concentrations of testosterone, 17 beta-estradiol, LH, FSH, cortisol, dehydroepiandrosterone (DHEA), and DHEA sulfate (DHEA-S) were measured before and after a 5-day course of IL-2 therapy. Cortisol levels rose and DHEA-S decreased insignificantly. DHEA declined, reaching a nadir (P less than 0.001) on day 6, and testosterone decreased significantly on day 2 and reached a nadir on day 6 (P less than 0.0001). Concentrations of both steroids then gradually rose. Estradiol rose on day 4 (P less than 0.001) and then declined. Neither LH nor FSH was affected significantly, although there was a rise in the mean level of LH after IL-2 therapy. Our results suggest that high dose IL-2 therapy in men affects both adrenal and testicular androgen production without inhibiting pituitary trophic hormone secretion. These effects of IL-2 on plasma sex steroids may be the result of cytokines stimulated by IL-2 therapy, rather than direct responses to IL-2.

Adult↗
PubMed1990

A double-blind crossover study to compare lysine acetyl salicylate (Aspergesic) with ibuprofen in the treatment of rheumatoid arthritis.

Lysine acetyl salicylate [1.8 g t.d.s. (Aspergesic 1,000 sachet)] has been compared to 400-mg ibuprofen tablets t.d.s. in a randomized double-blind trial in patients with rheumatoid arthritis using double-dummy technique. Both drugs proved effective in relieving symptoms. Three patients experienced drug-related side-effects with Aspergesic, and one patient with ibuprofen, that necessitated early discontinuation of treatment. Aspergesic was associated with a greater number of haemoglobin values falling below the normal range than ibuprofen. At the end of the study, eight out of 10 patients who expressed a preference selected Aspergesic for improving mobility whilst 15/24 selected Aspergesic for improving pain.

Adult↗
PubMed1985

The spatial frequency discrimination function at low contrasts.

Spatial frequency difference thresholds for sinewave gratings near contrast threshold were measured using a two-alternative forced-choice technique, and the threshold frequency differences were plotted as a proportion of standard frequency for standards from 2 to 7 cycles/degree. This function shows reliable local maxima and minima, and these features are more pronounced than they are when stimuli of 30% contrast are used. This result is consistent with the notion that at low contrasts, fewer spatial frequency channels are above threshold in the area of the visual field covered by the stimulus than when the stimulus is at high contrast.

Contrast Sensitivity↗