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Biomedical subjects

C Stark

Publications and source records attributed to C Stark.

At least 19 recordsLinked to original sources
PubMed2006

Suicide in farmers in Scotland.

INTRODUCTION: Farmers and farm workers have higher than expected rates of suicide and undetermined deaths in UK studies, and some rural areas of Scotland have higher than average male suicide rates. Firearm access seems to be an influencing factor in England and Wales. Type of farming, and farming social networks may also be important. This article describes suicide and undetermined deaths in male farmers and farm workers in Scotland from 1981-1999 using anonymised, routine data. METHOD: Deaths of men aged 15-74 years from suicide or undetermined cause were identified from anonymised Scottish death records. Farmers and farm workers were identified using occupation codes. Methods of suicide used by farmers were compared with those of the general male population of the same age. A multiple linear regression was used to examine the influence of farm type, and the proportion of farmers in the working population of an area. RESULTS: 307 male farmers or farm workers died by suicide or undetermined cause in the time period. The overall rate was 31.4/100,000 per year (95% CI 28.1-35.1). Deaths using firearms were over-represented (29% of farming deaths compared with 3.6% in the general male population). There was no significant association between the male suicide rate in an area, and the farming suicide rate. Areas with lower proportions of farmers tended to have higher rates of farming suicide and undetermined deaths. This one factor described 85% of the variance among areas. CONCLUSION: Deaths were substantially more likely to involve firearms than suicide and undetermined deaths in the general male population. Less use of other methods did not completely compensate for this, indicating that method availability is likely to contribute to farming suicide rates. Farmers in areas where farming is less common were more likely to die by suicide, and this described most of the differences among areas. Networks and social supports may be important protective factors for farmers.

Accidental Falls↗
PubMed2004

Newspaper coverage of a violent assault by a mentally ill person.

The media is an important source of public information on mental ill-health. A man with a serious psychiatric illness attacked a minister with a knife at a Remembrance Sunday service in a remote, rural part of the Highlands, inflicting a severe facial wound. We aimed to identify lessons for the National Health Service (NHS) from the media coverage of the incident and of a subsequent court case and NHS Highland inquiry and in addition to explore how newspaper reporters approached reporting such incidents. We searched local and regional, national Scottish, and the Scottish editions of three UK newspapers for relevant coverage. We also conducted structured telephone interviews with eight reporters who had attended the inquiry press conference. Most of the media coverage was associated with the assault and the court case, rather than the inquiry results. Only three of 10 inquiry recommendations were mentioned in any reports. Coverage largely dealt with identified shortfalls, rather than proposed solutions. The NHS had made little comment in advance of the announcement of the inquiry results. Most of the newspaper coverage had already occurred. The NHS therefore limited its opportunity to influence newspaper coverage. The interpretation of the results is limited by the size of the study, but the coverage of such events forms part of the discourse on mental health in the media episodes and may have some affect on public perception of mental health issues. We conclude that, without providing confidential information, the NHS should take a more active stance in providing information on the nature and treatment of mental illness in such instances, even in advance of court cases.

Attitude↗
PubMed2003

Deaths associated with restraint use in health and social care in the UK. The results of a preliminary survey.

Many aspects of the management of acutely disturbed behaviour have only relatively recently come under systematic scrutiny. Perhaps regrettably one of the last amongst the range of strategies that may be employed to be subjected to rigorous examination has been physical restraint. Considerable debate has recently taken place around what represents good practice in this sensitive and controversial area but the continuing dearth of research in some aspects of this area of practice has meant that this discussion has arguably been over reliant on 'expert' opinion. Questions continue regarding some fundamental issues of restraint, including the relative risks involved in alternative approaches, and anxieties have been expressed about the potential for injuries and death to result from restraint. This article outlines the results of a survey that sought to explore the incidence of deaths associated with restraint in health and social care settings in the UK. The outcome of an initial analysis of the cases identified is then discussed, with reference to the literature on restraint-related deaths, in order to identify the implications for practice.

Adult↗
PubMed2002

Suicide in the Highlands of Scotland.

OBJECTIVE: The Highlands have one of the highest suicide rates in Scotland. This paper describes suicide and deliberate self-harm in the Highlands in the last 20 years and explores possible reasons for the differences from the Scottish average. DESIGN: Retrospective analysis of routine data from the SMRI/SMR01 scheme and information on deaths from the Registrar General. Suicide and undetermined deaths were combined in the analysis. SETTING: Highland and Scotland 1978-98. RESULTS: The high rates in Highland are caused by an excess of male deaths. Highland has had consistently high male suicide rates over the 20 year period compared to Scotland. These differences do not disappear when deaths of non-Highland residents are excluded. By comparison, deliberate self-harm admissions follow a similar pattern to Scotland as a whole. Causes of death differed from Scotland as a whole, with an over-representation of drowning, gases and firearm deaths. CONCLUSION: Highland suicide rates are elevated compared to Scotland. This is mainly due to an excess of deaths in men up to the age of 74 years, and is not accounted for by deaths of non-residents. Female deaths are not elevated in comparison to the rest of Scotland. Male attempted suicide rates do not differ from Scotland. Lethality of method--drowning, car exhausts and firearms--may contribute to the elevated male death rates.

Female↗
PubMed2001

Social policy and mental illness in England in the 1990s: violence, moral panic and critical discourse.

Violence perpetrated by people experiencing mental illness poses a continuing challenge to practitioners and policy makers in the mental health field. It has been suggested, however, that policy developments in England during the period 1990--2000 became unduly dominated by the perceived need to prevent such violence and in particular that a 'moral panic' occurred following a series of high profile homicides perpetrated by people experiencing mental illness. This paper critically examines the ability of the moral panic theory to offer a cogent explanation of the relationship between media representations, public perceptions and developments in both social policy and legislation during the last decade. Its conclusions, however, suggest that the evidence does not support assertions of a moral panic and that of moral panic theory itself has serious flaws. Ultimately the paper suggests that we must look elsewhere, particularly to Foucault's conceptualization of discourse and to the work of Birkland, an American political theorist, in our search for an understanding of the relationship between events, ideas and social policy.

Homicide↗
PubMed2000

Effect of general practitioner hospitals on district general hospital bed use in the Highlands of Scotland.

OBJECTIVE: To examine hospital bed use by General Practices with and without access to General Practitioner beds. DESIGN: Information from the Contract Management System for General Medicine and Surgery, and from SMR returns for Geriatric Medicine and GP beds was used to compare hospital bed use in District General Hospitals (DGHs) and in General Practitioner beds for practices with and without access to GP beds. Age adjusted rates were calculated for overall use of each specialty. SETTING: All General Practices in the Highland Health Board area for December 1995-April 1997. RESULTS: Compared to practices with no access to GP beds, practices with access used 39.4% fewer bed days per 1000 patients for medical specialties; 18% fewer bed days for surgical specialties; 34.5% fewer bed days for geriatric medicine, and 4.9% fewer bed days for other DGH specialties. Taking into account GP bed day use, practices with access to GP beds used 6.1% more hospital bed days per 1000 patients than did practices with no access. CONCLUSION: These findings largely replicate work in England that found substantial decreases in General Medical and Geriatric Medicine bed use in Practices with access to GP beds, combined with an overall increase in occupied bed day use of 6-8% per 1000 patients. The lower use of surgical beds was unexpected, and may reflect more flexible use of GP beds in the Highlands for observation or rehabilitation, possibly related to the far greater distances involved than in the English studies.

Adolescent↗
PubMed2000

Anti-psychotic drug prescribing trends in primary care in Scotland 1994-97.

OBJECTIVE: To describe trends in the use of anti-psychotic drugs prescribed in Primary Care in Scotland. DESIGN: Information on prescription numbers and costs were obtained from the Pharmacy Prescribing Division. SETTING: Scotland 1994-1997. Results Prescriptions for anti-psychotic drugs in Primary Care in Scotland increased by 28% in the period April 1994-December 97. In the same period, quarterly costs increased from 523,971 Pounds to 1,339,215 Pounds, an increase of 155%. Ninety per cent of the increase is accounted for by use of the five drugs risperidone, sertindole, olanzapine, clozapine and quetiapine. Health Board areas vary markedly in their uptake of the new drugs. CONCLUSION: The use of new anti-psychotic drugs in Scotland represents a substantial additional investment in mental health care. This has happened with little discussion or debate. Scotland needs to make explicit decisions on the place of newer anti-psychotics in treatment, and on the balance between investing in these drugs and investing in other aspects of mental health services.

Antipsychotic Agents↗
PubMed2000

Drug action team strategies in Scotland.

OBJECTIVE: To compare the Strategic Plans of Scottish Drug Action Teams (DATs) to the recommendations of the Scottish Office Ministerial Task Force Report. DESIGN: Extraction of information from the strategic plans of DATs. SETTING: All 15 Scottish DATs 1995-96. RESULTS: Five DATs did not include a membership list in their Strategy, and two stated the organisations represented, but not the identity of individual members. Where individuals were identified, Health Boards, Social Work departments, Education and Police were always members. The median number of members was 12 (range 4-16). Most areas had plans to improve information on drug misuse. Every plan mentioned preventive work with young people. In Criminal Justice settings, use of Children's Hearings (20% of plans), substitute prescribing linked to probation (13%) and prison aftercare schemes (33%) were mentioned less commonly. Substitute prescribing (87% of DATs), the role of General Practitioners (100%) and monitoring mechanisms (87%) were the service issues mentioned most often. Of other service issues in the Ministerial Report, those mentioned least by DATs were childcare linked to services (20%); services for people from ethnic minorities (33%); education on dangers of injecting to existing drug users (33%); women--only residential services (33%); services for women (46%) and role of pharmacists (53%). CONCLUSION: Membership was from a core of statutory agencies. Young people were the priority of most DATs. Criminal Justice arrangements and services for special groups of people were not well developed in many plans. DATs should review their focus on these groups.

Adolescent↗
PubMed1999

Genetic structure, reproductive biology and ecology of isolated populations of asplenium csikii (Aspleniaceae, pteridophyta)

The potential for environmental heterogeneity to generate spatial structuring of genotypes in seed-plant populations that occupy patchy habitats has been demonstrated by several studies, but little is known about the population structure of pteridophytes occupying patchy environments. In this study we have examined the genetic structure of isolated populations of the rock fern Asplenium csikii, an ecological specialist, growing almost exclusively on perpendicular walls of natural rock outcrops. All genetic variation observed in this taxon was partitioned between localities; no allozyme variation was found within a site and each site was colonized by a single multilocus phenotype (MLP). In total, five different MLPs were recorded from the nine localities, with two MLPs present at more than one site. Previous examination of population structure and genetic diversity in another rock fern, A. ruta-muraria, showed that the genetic diversity increases through multiple colonization over time. However, we cannot find any such correlation for A. csikii. All populations are genetically uniform, despite the probably considerable age of the populations and sites. Earlier studies concluded that the ample production of wind-borne propagules would lead to multiple colonization of sites and that reproductive features, such as single-spore colonization and subsequent intragametophytic selfing, would lead to very little genetic structuring of fern populations. In contrast to this prediction, it appears that ecological specialization and the scarcity of the narrowly defined niche contribute strongly to the pronounced partitioning of genetic variability observed in populations of A. csikii.

Journal Article↗
PubMed1999

Changes in the pattern of work in a rural community hospital 1987-1997.

OBJECTIVES: To examine time trends in clinical activity at a rural community hospital, and to assess associated changes in the complexity of the care received by inpatients. DESIGN: Descriptive study utilising routine Scottish Morbidity Records data (SMRO1) and locally collected data, along with a retrospective review of admission case notes to quantify clinical inputs to patient care. SETTING: Portree community hospital on the island of Skye. SUBJECTS: Patients admitted to Portree community hospital in 1987, 1992 and 1997. RESULTS: We found an 80 per cent rise in total annual admissions between 1987 and 1997 and a 34 per cent rise in annual casualty attendance between 1992 and 1997. There was a significant reduction in the median duration of in-patient stay, from 8.5 days in 1987 to 6.0 days in 1997. The case-mix of admissions altered significantly between 1992 and 1997. We also demonstrated significant changes in the proportion of patients receiving blood transfusions or intravenous (i.v.) fluids during this time period. CONCLUSIONS: There have been significant changes in the pattern of use of this community hospital over the past 12 years. The rise in total admissions and casualty attendances, combined with the fall in duration of stay reveal an overall increase in activity at the hospital. This has been associated with changes in the clinical spectrum of admissions. Taken together with the results of the workload analysis, it seems likely that the complexity of the clinical input required at the hospital has increased, and that the role of this community hospital is increasingly the provision of intermediate care to acute cases.

Aged↗
PubMed1998

Effect of femoral head surface roughness on the wear of ultrahigh molecular weight polyethylene acetabular cups.

We studied the effect of femoral head surface roughness on the wear of ultrahigh molecular weight polyethylene (UHMWPE) acetabular cups using a hip joint simulator and a reciprocating wear tester. Compared with the hip simulator, the reciprocating wear tester severely exaggerates the effect of counterface roughness on UHMWPE wear and drastically underestimates the wear rate of the UHMWPE against smooth undamaged counterfaces. According to the hip simulator test results, the wear rate of the UHMWPE cups is approximately proportional to the square root of the femoral head roughness Ra (center-line-average roughness) rather than to Ra raised to a power greater than one as predicted by pin-on-disk studies. Roughening of the femoral heads by an order of magnitude results in a 2- to 3-fold increase in the wear rate. Therefore, the much wider clinical variations of wear cannot be fully explained by variations in surface roughness of the femoral heads.

Acetabulum↗
PubMed1998

Efficacy of oral iron supplementation is not enhanced by additional intravenous iron during autologous blood donation.

BACKGROUND: The study compared the efficacy of oral iron combined with intravenous iron supplementation to that of oral iron supplementation alone in increasing the preoperative production of hemoglobin (Hb) in autologous blood donors with normal iron stores. STUDY DESIGN AND METHODS: One hundred eight iron-replete patients who were scheduled for donation of 3 units of autologous blood at weekly intervals were randomly assigned to receive, in a double-blind fashion, no iron supplementation (placebo, Group 1), oral iron supplementation (285.6 mg of elemental iron/day, Group 2), or oral iron plus intravenous iron supplementation (285.6 mg of elemental iron/day orally plus 102.5 mg of elemental iron/week intravenously, Group 3). The amount of Hb produced during the 21-day study period was determined by the total amount of Hb donated minus the change in the amount of circulating Hb between the first donation (Day 0) and the poststudy examination (Day 21). RESULTS: Hb production did not differ significantly in the two iron-supplemented groups (oral iron, 85 +/- 36 g; oral plus intravenous iron, 74 +/- 43 g). The patients in the oral iron group produced a significantly greater amount of Hb than those in the placebo group (85 +/- 36 g vs. 52 +/- 41 g, p < 0.01). CONCLUSION: Oral iron supplementation increased the production of Hb in autologous blood donors more than placebo did. Additional intravenous iron did not lead to a further increase in preoperative Hb production.

Administration, Oral↗
PubMed1998

Immunohistochemical visualization of wild-type p53 protein in paraffin-embedded rat liver using tyramide amplification: zonal hepatic distribution of p53 protein after N-hydroxy-2-acetylaminofluorene administration.

P53 protein plays an important role in regulation of the cell cycle. Recently, a role in tumour genesis has also been suggested. The protein is induced after various forms of DNA damage. Immunohistochemical detection of p53 protein showed positive cells in human skin after UV-irradiation, in mouse skin after benzo[a]pyrene treatment and in mouse spleen, thymus and bone after gamma-irradiation. However, no staining was found in mouse and rat liver with traditional immunohistochemical staining methods due to the low amount of p53 present. This seriously hampered studies on the role of p53 in hepatocarcinogenesis. We have developed a more sensitive immunohistochemical method for staining of p53 in paraffin-embedded sections of rat liver using microwave irradiation for antigen retrieval, avidin-biotin complexing and tyramide amplification. A strong, specific fluorescence signal for p53 was found in hepatocytes of rats that had received the hepatocarcinogen N-hydroxy-2-acetylaminofluorene; in control liver no such p53 staining was observed. The fluorescence was located in the nucleus of hepatocytes in zone 1 of the liver. This agrees with the fact that N-hydroxy-2-acetylaminofluorene causes cytotoxicity in this zone.

Animals↗
PubMed1998

Thirteen-year follow-up of deliberate self-harm, using linked data.

BACKGROUND: We describe a national cohort of individuals surviving an episode of deliberate self-harm (DSH). Subsequent admissions for DSH and mortality over the following 13 years were studied. METHOD: In 1981, 8304 individuals were discharged from Scottish general hospitals with a diagnosis of attempted suicide (E950-959). They were followed-up to the end of 1994 using the Scottish Linked Data Set. Mortality was compared to the Scottish population using person-years analysis. RESULTS: 2624 people (31.6%) were readmitted with further episodes of DSH. The median number of readmissions was 1, range 1-137. The observed:expected ratio for all-cause mortality was 2.26 (95% CI 2.13-2.26). One hundred and sixty-eight people (2%) died from suicide, and 46 (0.6%) from undetermined causes. The observed:expected ratio for suicide plus undetermined deaths was 12.17 (95% CI 10.64-13.91). Accidental deaths in men and homicide deaths in men and women were elevated. The pattern of deaths from other causes suggested that alcohol misuse was a contributory factor. CONCLUSIONS: People admitted to general hospitals in Scotland after attempted suicide are at high risk of readmission for further episodes of DSH. Long-term follow-up of such large cohorts is impractical, but services should review the scope for intervention in alcohol misuse following DSH.

Adolescent↗