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D Brewster

Publications and source records attributed to D Brewster.

At least 37 records · Page 2Linked to original sources
PubMed1995

Registration of colorectal cancer in Scotland: an assessment of data accuracy based on review of medical records.

Colorectal cancer accounts for a substantial burden of morbidity and mortality in the population. While the need for reliable incidence data may be self-evident, the quality of cancer registration data has rarely been assessed. In Scotland during 1993, the medical records of a random sample of cancer registrations attributed to the year 1990 were sought. The sample contained 238 registrations of colorectal cancer, 217 (91%) of which had relevant medical records available for review. Registration details were reabstracted from available records and compared with data in the registry. Discrepancies in identifying items of data (surname, forename, sex and date of birth) were recorded in eight cases (3.7%, 95% confidence intervals 1.2-6.2%). None would have disturbed record linkage. Discrepancy rates of 3.7% (1.2-6.3%) in postcode of residence at the time of diagnosis (excluding differences arising through boundary changes), 8.3% (4.6-12.0%) in 'anniversary date' (excluding differences of 30 days or less), 2.8% (0.6-5.0%) in histological verification status and 13.5% (8.9-18.1%) in morphology code (excluding 'inferred' morphology codes) were recorded. Twelve cases (5.5%, 2.5-8.6%) were deemed not to warrant site codes for cancer of the colon (ICD-9 153) or rectum (ICD-9 154). In many respects, therefore, the data held about registrations of colorectal cancer in Scotland appear to show a high level of accuracy. Completeness of case ascertainment has still to be formally assessed.

Abstracting and Indexing↗
PubMed1995

Registration of non-melanoma skin cancers in Scotland--how accurate are site and morphology codes?

Although under-reporting of non-melanoma skin cancers to cancer registries is widely acknowledged, less is known about the accuracy of information held about registered cases. In 1993, the accuracy of a random sample of cancer registrations in Scotland attributed to the year 1990 was assessed by reference to relevant medical records. The sample contained 290 registrations of non-melanoma skin cancers, 251 (90%) of which had records available for scrutiny. Here we report the results of a detailed analysis of the accuracy of site and morphology coding of non-melanoma skin cancers. Following reabstraction of details from available medical records, only three cases (1.2%) did not retain the same first three digit ICD-9 site code (173.--), although a further three cases were judged to have been registered in error. There were 56 (21.5%) discrepancies in morphology coding, but 21 of these arose through inferences about morphology in the absence of microscopic confirmation, and most of the remainder were of a relatively minor nature. In summary, it does seem possible to collect data about non-melanoma skin cancers to a reasonably high standard of accuracy. This provides some justification to those who advocate an increased effort directed towards improving levels of completeness of case ascertainment.

Humans↗
PubMed1995

Improving the quality of cancer registration data.

Cancer registration is an essential element of any cancer control strategy. Data quality is, however, of paramount importance. This paper sets out some of the ways in which the quality of cancer registration data might be improved. In particular, the potential contribution of clinicians and pathologists is highlighted.

Data Collection↗
PubMed1994

How accurate are Scottish cancer registration data?

In order to assess the accuracy of Scottish cancer registration data, a random sample of 2,200 registrations, attributed to the year 1990, was generated. Relevant medical records were available for review in 2,021 (92%) cases. Registration details were reabstracted from available records and compared with data in the registry. Discrepancies in identifying items of data (surname, forename, sex and date of birth) were found in 3.5% of cases. Most were trivial and would not disturb record linkage. Discrepancy rates of 7.1% in post code of residence at the time of diagnosis (excluding differences arising through boundary changes), 11.0% in anniversary date (excluding differences of 6 weeks or less), 7.7% in histological verification status, 5.4% in ICD-9 site codes (the first three digits) and 14.5% in ICD-O morphology codes (excluding 'inferred' morphology codes) were recorded. Overall, serious discrepancies were judged to have occurred in 2.8% of cases. In many respects, therefore, Scottish cancer registration data show a high level of accuracy that compares favourably to the reported accuracy of the few other cancer registries undertaking such analyses.

Female↗
PubMed1993

Initial effects of the grounding of the tanker Braer on health in Shetland. The Shetland Health Study Group.

OBJECTIVE: To determine if the oil spillage from the tanker Braer had any immediate health effects on the exposed resident population. DESIGN: Cohort study with a comparison against controls, exposure status being assigned on the basis of geographical location. SETTING: Rural Shetland. SUBJECTS: All those resident on or after 5 January 1993 (day 0) within 4.5 km of the site of tanker's grounding. Controls matched for sex and age were drawn from a general practice list 95 km distant. OUTCOME MEASURES: Demographic details; smoking and alcohol consumption; perception of health and reported presence or absence of specific symptoms; peak expiratory flow; results of haematology, liver and renal function tests, and blood and urine toxicology. RESULTS: Of subjects contacted, 420 (66%) exposed people and 92 (68%) controls were studied; 56 non-attenders were surveyed. Principal health effects arose on days 1 and 2 and were headache, throat irritation, and itchy eyes. No significant differences between those exposed and controls were found for any of the biological markers. Toxicological studies did not show any exposures that are known to affect human health. CONCLUSIONS: The study confirmed the anecdotal reports of certain acute symptoms. No evidence of pulmonary, haematological, renal, or hepatic damage was detected at the population level. Toxicological samples from exposed people did not find levels known to affect human health. Further studies are required to ascertain whether there have been any long term effects on the population.

Acute Disease↗
PubMed1993

Surveillance of measles in Scotland 1983-1991; a comparison of statutory notification and laboratory reporting.

The epidemiology of measles in Scotland for the period 1983-1991, based on statutory notification and laboratory reporting, is described. There were 34,823 notifications compared to only 690 laboratory reports. This suggests that for less than 1 in 50 notifications of measles was the clinical diagnosis confirmed by laboratory testing. Both sets of data show a declining incidence of measles (in keeping with rising rates of immunisation) but a statistically significant shift in the age distribution of cases towards the over 15 years age group. There were differences, however, between the two sets of data in the sex ratio within various age groups. In particular, among notified cases, there was a highly significant but unexplained preponderance of males in the over 15 years age group (59.7% vs. 40.3%, P < 0.001). Discrepancies between the two sets of data were also evident from comparisons among Health Boards. Possible sources of bias are suggested for each set of data. The relevance of this surveillance to the current debate about the need for a two stage Measles/Mumps/Rubella (MMR) immunisation policy is briefly discussed. In order that this debate be reliably informed, it is highly desirable that the clinical diagnosis in each case of apparent vaccine failure is confirmed by laboratory testing.

Adolescent↗
PubMed1993

The epidemiology of Haemophilus influenzae invasive disease in Scotland prior to immunisation.

Immunisation against Haemophilus influenzae b (Hib) was added to the UK childhood vaccination schedule on 1 October 1992. Based on reports of laboratory isolations from blood and/or CSF, the epidemiology of Haemophilus influenzae invasive disease in Scotland during the last full year before immunisation (1991) is reviewed. In children aged under five years the estimated incidence of infection (25.5 per 100,000) is higher than that previously reported from Scotland, but lower than estimates from Glasgow and other UK studies. However, the age-sex and seasonal distribution is consistent with previous surveys. As in England and Wales, there appears to be regional variation in incidence within Scotland, although this may simply reflect differences in the completeness of laboratory reporting. In addition to 113 laboratory reports of H. influenzae invasive infection, a retrospective search of hospital discharge data and death registrations identified a further 51 and two cases respectively, some of whom may be genuine. In spite of reservations about hospital discharge data, this raises the possibility that there may be an element of under-reporting by laboratories. With the advent of record linkage of hospital discharge data, it would be prudent to monitor the impact of the Hib vaccine programme using this data source in addition to laboratory reports and death registrations.

Adolescent↗
PubMed1992

Comparison of artemether and chloroquine for severe malaria in Gambian children.

Artemether is an oil-soluble methyl ether of artemesinin (qinghaosu). It has been studied extensively in China, where it has been shown to be rapidly effective in severe falciparum malaria. Nearly all the patients studied previously were adults. We have investigated the efficacy of artemether in children with moderate or severe falciparum malaria. In the preliminary study of moderately severe malaria, 30 Gambian children were randomised in pairs to receive either intramuscular artemether (4 mg/kg loading dose followed by 2 mg/kg daily) or intramuscular chloroquine ('Nivaquine') 3.5 mg base/kg every 6 h. Both drugs were well tolerated and rapidly effective. The times to parasite clearance were significantly shorter in the artemether recipients (mean 36.7 [SD 11.3] vs 48.4 [16.8] h, p less than 0.05). 43 children with severe malaria were then randomised to receive intramuscular treatment with the same regimens of artemether (n = 21) or chloroquine (n = 22) as used in the preliminary study. 8 children (19%) died. There were no significant differences between the two groups in the clinical, haematological, biochemical, or parasitological measures of therapeutic response in survivors and there was no evidence of local or systemic toxicity. Despite similar parasite counts on admission, clearance times overall were longer in severe malaria than in moderate malaria. Artemether is a well tolerated and rapidly effective parenteral treatment for severe malaria in children, and would be especially valuable in areas with chloroquine-resistant P falciparum.

Animals↗
PubMed1992

Interethnic genetic differentiation in Africa: HLA class I antigens in The Gambia.

A total of 752 individuals from The Gambia, west Africa who are representative of the major ethnic groups in the capital, Banjul, were serologically typed for HLA-A, -B, and -C antigens. Although all were typically "African" in their antigenic profiles, some marked frequency differences were found between the ethnic groups. Genetic distance comparisons with several other African populations showed that, although these west African populations clustered closely together, the positions of the various ethnic groups in The Gambia were consistent with historical and linguistic evidence of their affinities with one another and with other African populations. Despite the potential confounding effects both of selection by infectious diseases and of genetic drift caused by local differences in population structure, HLA frequencies appear to be of value in measuring inter- and intraregional population affinities in sub-Saharan Africa.

Africa↗
PubMed1991

Common west African HLA antigens are associated with protection from severe malaria.

A large case-control study of malaria in West African children shows that a human leucocyte class I antigen (HLA-Bw53) and an HLA class II haplotype (DRB1*1302-DQB1*0501), common in West Africans but rare in other racial groups, are independently associated with protection from severe malaria. In this population they account for as great a reduction in disease incidence as the sickle-cell haemoglobin variant. These data support the hypothesis that the extraordinary polymorphism of major histocompatibility complex genes has evolved primarily through natural selection by infectious pathogens.

Animals↗
PubMed1991

Sequence analysis of HLA-Bw53, a common West African allele, suggests an origin by gene conversion of HLA-B35.

In the West African population of the Gambia the class I antigen HLA-Bw53 is found at high frequency. We used the polymerase chain reaction to amplify cDNA from an individual homozygous for this allele and determined the nucleotide sequence of the polymorphic alpha 1 and alpha 2 domains. The HLA-Bw53 sequence is identical to HLA-B35 except for a short sequence at the 3' end of exon 2 (encoding the alpha 1 domain) which specifies a Bw4 rather than a Bw6 motif. This suggests an origin for HLA-Bw53 involving a gene conversion of HLA-B35 by an allele containing this Bw4 sequence. The alpha 2 domain shared by HLA-Bw53, -B35, and -Bw58 is particularly common in sub-Saharan Africans.

Adult↗
PubMed1991

An evaluation of different ibuprofen preparations in the control of postoperative pain after third molar surgery.

1. Two separate placebo-controlled studies of parallel design were carried out to evaluate the efficacy of single doses (400 mg) of soluble ibuprofen, ibuprofen liquid in a gelatin capsule and ibuprofen tablets (Nurofen), in patients with postoperative pain after third molar surgery. 2. All ibuprofen preparations provided significant pain relief (P less than 0.05) over a 6 h investigation period. 3. Mean pain scores after ibuprofen tablets and ibuprofen liquid in a gelatin capsule were similar. 4. Soluble ibuprofen 400 mg provided an earlier onset of pain relief (20 min) than ibuprofen tablets (30 min). 5. No unwanted effects were reported in the various ibuprofen treatment groups. 6. The ibuprofen preparations evaluated in this study are effective up to 4 h for controlling postoperative pain after third molar surgery. The soluble form is more efficacious with regard to onset of action.

Adolescent↗