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PubMed1998

CleftNet (Scotland): a network for the treatment of cleft palate speech using EPG.

Electropalatography (EPG) has proven its effectiveness in changing abnormal articulatory placement in cleft palate speech but clinicians often do not have ready access to such equipment. In order to improve access to EPG therapy, a network has been established which electronically links cleft palate centres throughout Scotland with EPG specialists based at Queen Margaret College (QMC), Edinburgh. The network was set up through a collaborative project entitled 'CleftNet Scotland', funded by the Scottish Office Department of Health. In this paper, the rationale and overarching aims of CleftNet Scotland are described and the efficacy of this form of EPG therapy illustrated by descriptions of two cases.

Child↗
PubMed1997

Dosage of antidepressant medication dispensed in Scotland.

OBJECTIVES: To examine the daily doses of the more frequently prescribed antidepressants in Scotland and to assess the extent of adequate dosage and its relationship to drug type. DESIGN: Monthly random sample of all prescriptions dispensed in Scotland over 1 year. Antidepressants were categorised into 5 groups, older tricyclics, newer tricyclics, atypical antidepressants, selective serotonin uptake inhibitors (SSRI's) and monoamine oxidase inhibitors (MAOI's). Percentage of prescriptions at or above the minimum effective dose was calculated for each group. In addition the total number and rank order of all antidepressant prescriptions in 1995 were calculated in order to examine sampling bias. SETTING: Prescription data routinely collected by the Pharmacy Practices Division of the Common Services Agency of The NHS in Scotland. RESULTS: Older tricyclics continue to be the most frequently prescribed antidepressants (51%), followed by SSRI's (34%), newer tricyclics and atypicals (7% each) and MAOIs (1%). Only 18% (95% C.I. 13-23%) of the sample of older tricyclics were prescribed at or above the minimum therapeutic level, compared to 99% (95% C.I. 95-100%) for SSRIS' 76% (95% C.I. 55-93%) for atypicals and 74% (95% C.I. 52-96%) for lofepramine. CONCLUSIONS: Despite initiatives to improve the treatment of depressive illness in primary care, the majority of prescriptions continue to be for older tricyclic antidepressants at sub-therapeutic dosage. Incorporation of consensus statement guidelines about minimum effective doses for these drugs in the BNF may be an important and economical route to improving treatment of identified depressive illness.

Antidepressive Agents↗
PubMed2002

Incidence of invasive pneumococcal disease in Scotland, 1988-99.

A review of the epidemiology of invasive pneumococcal disease in Scotland was carried out using data from laboratory-based systems during the period 1988-99. This comprised 5456 (90.8%) isolates of Streptococcus pneumoniae from blood, 467 (7.8%) from cerebrospinal fluid (CSF) and 84 (1.4%) from other sterile sites. The mean annual incidence of invasive disease was 9.8/10(5) population (9.0/10(5) for bacteraemia and 0.8/10(5) for meningitis). Invasive disease was highest in children < 2 years of age and in the elderly > or = 65 years (44.9/10(5) and 28.4/10(5) population in these age groups respectively). The highest incidence of pneumococcal meningitis, 11.8/10(5) persons occurred in children < 2 years of age. Males had a higher incidence of pneumococcal bacteraemia and meningitis than females (male:female = 1.2:1 for bacteraemia (RR = 1.17, 95 % CI 1.11, 1.24) and 1.5:1 for meningitis (RR = 1.41, 95 % CI 1.18, 1.70)). Pneumococcal disease was highest in winter periods and coincided with influenza activity. The proportion of penicillin and erythromycin non-susceptible isolates increased from 4.2% in 1992 to 12.6% in 1999 and from 5.6% in 1994 to 16.3% in 1999 respectively. Our data confirm the substantial and increasing disease burden from pneumococcal disease and rise in prevalence of antibiotic non-susceptibility among pneumococci in Scotland. Continued surveillance of groups at increased risk for pneumococcal disease and the antibiotic susceptibility and serotype distribution of isolates are important to develop appropriate policies for the prevention of pneumococcal disease in Scotland.

Adolescent↗
PubMed1999

Shaping the future: a primary care research and development strategy for Scotland.

Primary care is at the centre of the National Health Service (NHS) in Scotland; however, its R & D capacity is insufficiently developed. R&D is a potentially powerful way of improving the health and well-being of the population, and of securing high quality care for those who need it. In order to achieve this, any Scottish strategy for primary care R&D should aim to develop both a knowledge-based service and a research culture in primary care. In this way, decisions will be made based upon best available evidence, whatever the context. Building on existing practice and resources within primary care research, this strategy for achieving a thriving research culture in Scottish primary care has three key components: A Scottish School of Primary Care which will stimulate and co-ordinate a cohesive programme of research and training. A comprehensive system of funding for training and career development which will ensure access to a range of research training which will ensure that Scotland secures effective leadership for its primary care R&D. Designated research and development practices (DRDPs) which will build on the work of existing research practices, in the context of Local Health Care Co-operatives (LHCCs) and Primary Care Trusts (PCTs), to create a co-operative environment in which a range of primary care professionals can work together to improve their personal and teams' research skills, and to support research development in their areas. A modest investment will create substantial increases in both the quality and quantity of research being undertaken in primary care. This investment should be targeted at both existing primary care professionals working in service settings in primary care, LHCCs and PCTs, and at centres of excellence (including University departments). A dual approach will foster collaboration and will allow existing centres of excellence both to undertake more primary care research and to support the development of service based primary care professionals in their research. Resources should be distributed equitably, taking into account demography, geography and the health needs of patients in Scotland. The strategy and its components must be seen as a whole. The Scottish School of Primary Care will stimulate and co-ordinate both research and training programmes. DRDPs will become research active and will participate in School-led training and research, and will contribute to research programmes. Comprehensive funding for training and career development will ensure that staff have the skills to participate in both DRDPs and in the School's activities. Thus, inadequate commitment to any one component of the strategy will mean that other components will be less successful. Commitment to all three components will maximise the chances of success.

Health Services Research↗
PubMed2001

Child and adolescent forensic psychiatry survey--in Scotland.

OBJECTIVES: To review the provision of Adolescent Forensic Services, and assess the need for the development of a separate service as exists for adult mentally disordered offenders. DESIGN AND SUBJECTS: To investigate by postal survey to all child and adolescent psychiatrists in Scotland. RESULTS: There is a lack of forensic adolescent expertise in Scotland and a perceived need for it. Child and adolescent psychiatrists are required to deal with difficult forensic cases, without appropriate training. CONCLUSION: A child and adolescent forensic service for Scotland needs to be developed.

Accreditation↗
PubMed2000

The boom that never was: results of a 10 year audit of paediatric growth hormone prescribing in Scotland.

OBJECTIVE: To investigate trends in paediatric growth hormone (GH) prescribing in Scotland. DESIGN: Annual audit of paediatric GH patients, analysed by geographical distribution, diagnosis, age and duration of treatment, dosage, sex ratio and prescribing body. SUBJECTS AND SETTING: Paediatric patients receiving GH who attended the four tertiary referral centres in Scotland: Glasgow, Edinburgh, Dundee and Aberdeen, from 1990-1999. RESULTS: The annual total number of paediatric GH recipients ranged from 296-393. The maximum was recorded in 1994, with a progressive decline thereafter. The latest total (296, 1999) represents a 19% decrease since 1990. There is a marked disparity between these figures and projections published by the Scottish Office Clinical Research and Audit Group (CRAG) in 1990 of 500 patients in 1995 and 600 by 2000. CRAG postulated that GH would prove efficacious in a wider range of conditions, that the number of survivors of childhood cancer would increase and that GH therapy would continue following clinical trials. While there has been a relative increase in oncology survivors during the 10-year period, the overall decline in numbers is largely attributable to familial short stature patients in whom there has been a five fold decrease, following completion of clinical trials of GH. The number of children classified "idiopathic growth hormone deficient" has also decreased, as the overlap between this condition and normal variant short stature is increasingly recognised. CONCLUSION: This expensive drug is being used relatively conservatively in Scotland, in the light of research experience. While a small degree of ad hoc usage is inevitable, we strongly support participation in national trials wherever possible. The adoption of an open approach with the Scottish Office regarding GH usage has proved beneficial in alleviating fear of escalating costs and preventing prescribing problems in a country in which 98% of GH is prescribed by general practitioners.

Adolescent↗
PubMed2000

Gastrointestinal infections presenting in general practice in Scotland.

OBJECTIVES: To determine the incidence of gastrointestinal infections (GII) presenting to general practitioners (GPs) in Scotland, To record the demographic and clinical characteristics of persons presenting with GII, To determine the proportion and characteristics of GII investigated in the laboratory, To report on the microbiological aetiology of the GII. DESIGN: Descriptive epidemiological study. SETTING: Twenty three general practices in Scotland serving a total practice population of 152,471. SUBJECTS: Patients consulting their GPs for a 'gastrointestinal infection' which met the study case definition. RESULTS: These are presented for the 3872 patient consultations for GII between April 1996 and December 31st 1997 which met the survey case definition. The crude annual rate of new consultations recorded was 1.7 per 100 person years. The crude monthly consultation rate for new cases ranged between 11 and 18 per 10,000 patients. GPs notified 9% of the cases as 'food poisoning'. A request for microbiological testing of samples at the local laboratory for clinical reasons was documented for 34% of cases with diarrhoea. The study laboratory received faecal samples by post from 66% of these cases. About one in five of the samples tested revealed evidence of infection with a common gastrointestinal pathogen. The pathogens most frequently reported were Campylobacter sp and Salmonella sp. CONCLUSION: The incidence of consultations for GII in Scotland is similar to that recorded in a recent survey in England. The very low notification rate by GPs means that statutory notification by telephone or post is a poor basis for early warning of outbreaks. It is recommended that a pilot study of electronic notification using the NHS net is set up.

Adolescent↗
PubMed2003

Modelling the influence of irrigation abstractions on Scotland's water resources.

Legislation to control abstraction of water in Scotland is limited and for purposes such as irrigation there are no restrictions in place over most of the country. This situation is set to change with implementation of the European Water Framework Directive. As a first step towards the development of appropriate policy for irrigation control there is a need to assess the current scale of irrigation practices in Scotland. This paper presents a modelling approach that has been used to quantify spatially the volume of water abstractions across the country for irrigation of potato crops under typical climatic conditions. A water balance model was developed to calculate soil moisture deficits and identify the potential need for irrigation. The results were then combined with spatial data on potato cropping and integrated to the sub-catchment scale to identify the river systems most at risk from over-abstraction. The results highlight that the areas that have greatest need for irrigation of potatoes are all concentrated in the central east-coast area of Scotland. The difference between irrigation demand in wet and dry years is very significant, although spatial patterns of the distribution are similar.

Agriculture↗
PubMed2004

Whole population secondary prevention of coronary heart disease in Scotland: the HEARTS database.

Implementing the evidence base for the management of chronic disease is as challenging as discovering which interventions are effective. The HEARTS collaboration (Heart disease Evidence-based Audit and Research in Tayside Scotland) is achieving that goal for the secondary prevention of coronary heart disease (CHD by linking national databases to manually validated hospital and family practice electronic patient records. Specific data from the system is fed back to practices in a facilitated educational process and through the NHS intranet. This paper describes some of the key features of this strategic decision support system. All residents of the Tayside region of Scotland (n=484,013 mid year estimate 2002) are covered by the system. 9,828 patients who have suffered a myocardial infarction(MI) or who have undergone angioplasty or bypass surgery are registered on the system. Improvements in clinical status and prescribing of effective therapies are 5-10% greater than elsewhere in Scotland.

Angioplasty, Balloon, Coronary↗
PubMed1981

The status of hospital discharge data in Denmark, Scotland, West Germany, and the United States.

This section has surveyed characteristics of the health service systems in Denmark, Scotland, West Germany, and the United States. Certain characteristics in each country are likely to increase hospital utilization. In the United States the characteristics include economic incentives to physicians and patients for hospital use and the high percent of physicians in specialty practices. In Denmark the high proportion of hospital-based physicians may increase hospital use. In Scotland the use of capitation to pay office-based physicians and the absence of a nursing home system probably increase hospital use, and in West Germany the large number of physicians per population and the lack of sufficient alternative facilities for long-term care are likely to increase hospital use. On the other hand, each health services system has some characteristics that should decrease hospital use: for instance, the large number of alternative facilities for long-term care in the United States, the well-established programs for home care in Denmark and Scotland, and the small percent of physicians who are specialists in West Germany. Further research is needed to understand the interactions of these factors and the effects they have on hospital use. Increased understanding of the effects of health services system characteristics should result in more useful comparisons of hospital utilization statistics.

Adolescent↗
PubMed1989

Haplotype distribution of the human phenylalanine hydroxylase locus in Scotland and Switzerland.

RFLP haplotypes at the phenylalanine hydroxylase (PAH) locus were determined in 45 nuclear Caucasian families from Switzerland and Scotland. The RFLPs at the PAH locus are highly informative, and prenatal diagnosis is possible in 85% of the families studied. The data were combined with the profiles previously observed in the Danish population, in order to study the variation in RFLP haplotype distribution among European populations. A total of 22 different haplotypes were observed in Denmark, Switzerland, and Scotland. Fifteen and 19 haplotypes are associated with the normal (non-PKU) and with the mutant chromosomes, respectively. The haplotype distribution and the allele frequency of normal chromosomes remain constant between Denmark, Switzerland, and Scotland. However, both the haplotype distribution and allele frequencies of mutant chromosomes show significant variation between the three countries. Our results suggest there may be additional mutations in the PAH gene that cause PKU.

Alleles↗
PubMed1989

The operation of the Mental Health (Scotland) Act 1984 in one psychiatric hospital.

The Mental Welfare Commission for Scotland has commented on tentative evidence of the increasing use of compulsory detention in Scotland. Findings at Crichton Royal Hospital, Dumfries show that the number of patients detained annually has changed little since the introduction of the Mental Health (Scotland) Act 1984, but that more patients are being transferred from emergency to further detention, and that the average length of detention has risen sharply, with almost a half being detained for more than 28 days. The question is posed: are Scottish patients being well served by the Act--and by Scottish psychiatrists?

Commitment of Persons with Psychiatric Disorders↗
PubMed1988

Surveillance programme for the control of foodborne infections and intoxications in Europe: the first 6 years' experience in Scotland, 1980-85.

In 1979 WHO recommended the establishment of a surveillance programme in Europe for foodborne infections and intoxications that incorporated an early warning system for incidents affecting more than one country as well as a routine reporting system to record details of outbreaks of foodborne disease. The Early Warning System was introduced in Scotland in July 1979 and the Routine Reporting System in January 1980. By the end of 1985, 23 European countries were participating in the programme.The introduction of the surveillance programme in Scotland permitted the formation of a standard national reporting system for foodborne infections and intoxications. During the 6 years from 1980 to 1985, the major features of the programme in Scotland have been the introduction of compulsory pasteurization of cows' milk, in 1983, with the consequent eradication of general outbreaks of milkborne salmonellosis; the emergence of poultry meat as the major food vehicle of infections; and the development of techniques for costing foodborne disease outbreaks.

Animals↗
PubMed1982

Cancer of larynx in west of Scotland. A review of results and a consideration of new therapeutic approaches.

A recent epidemiological study carried out by the Cancer Intelligence Unit in Glasgow has shown: 1) there has been an increase in consumption of tobacco products and alcohol in Scotland over the past 25 years; and 2) the mortality rate from cancer of the larynx has been unchanged over that time (Fig. 1). Ayrshire, a county in the west of Scotland, has a population of 360,000 which is remarkably similar in age structure, sex and urban/rural mix to Scotland as a whole. The incidence of carcinoma of the larynx in this region has been unchanged over the 20-year period 1959-1978. The results of treatment for the period 1958-1968 were reported recently by Quayum. In this report the results of treatment of carcinoma of the larynx by radiotherapy in Ayrshire and district over the decade 1968-1978 are presented and compared with those of the previous decade. The overall survival is unchanged over the two decades 1958-68 and 1968-78. This confirms the findings of the Cancer Registry. The survival of certain stages has improved, though this may be due to changes in criteria for staging introduced in 1974. All cases in this report were staged retrospectively. Recent innovations in treatment which may improve overall survival are considered.

Adult↗
PubMed1982

Medical, veterinary and environmental liaison activities in Scotland.

The past decade has seen many changes in the relationships between the medical, veterinary and environmental health professions in Britain. Doctors and veterinarians had traditionally tended to remain in isolation to each other despite mutual interests, while working relationships between public health doctors and environmental health officers were disrupted following re-organization of the NHS in 1974 and of local government in 1975. The situation was, however, generally less acute in Scotland where active encouragement had been given since the early 1970s towards the creation of local liaison groups in different areas of the country, the first of which was formally established in Aberdeen in 1969. The subsequent development of other liaison groups and the role of the Communicable Diseases (Scotland) Unit in coordinating inter- and intra-professional liaison and communications throughout Scotland is described, along with examples of combined activities in surveillance, investigation and control measures.

Animals↗
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↗
PubMed1993

Asthma in Scotland: epidemiology and clinical management.

Asthma in Scotland is briefly reviewed including epidemiology, management and the potential for research, education and audit. Asthma is characterised by variable wheeze and shortness of breath caused by variable narrowing of the bronchial airways secondary to inflammation. Confusion with chronic obstructive airways disease is increasingly common in the elderly and epidemiological studies tend to focus on the age range 5-44 years. Asthma prevalence is critically dependent on the definitions used and exceeds 20% based on questionnaire alone, less if objective measurements of airways obstruction is also used: perhaps 15% in children, 5% in adults in Scotland. Comparisons between studies and countries are therefore potentially hazardous. Routine information sources confirm the high levels of morbidity and use of health services by asthmatic patients. A true increase in the prevalence of asthma in children over the last two decades appears likely. This has been compounded by increased willingness to use the diagnostic label of asthma. Asthma, hayfever and eczema have increased significantly in Aberdeen school children over the last 25 years and asthma symptoms and airways obstruction have increased significantly in South Wales. Similar increases are reported in New Zealand children between 1975 and 1985, the prevalence being significantly higher than in Welsh children using standardised methodology. In Zimbabwe an intriguing strong association has been demonstrated between asthma, urban life style and higher socio economic groups. Most asthma deaths are caused by bronchial narrowing and subsequent asphyxia. Asthma mortality has apparently increased in most industrialised countries but problems of definition remain even when attention is confined to the age span 5-44 years. The epidemic of asthma deaths in mid-60s was undeniable and may have reflected good symptomatic control by bronchodilators, which made doctors and patients neglect the underlying risk of asthma death. A gradual increase in asthma mortality in western countries over the 1970s and 1980s is apparent, including almost 5% annual increase in England and Wales between 1974 and 1984 which then levelled off. This may again reflect excess dependence on bronchodilator treatment and under-usage of steroid treatment. A more dramatic increase in mortality in New Zealand in the early 1980s is likely to have a number of contributory factors. In contrast, the mortality rate in Scotland had been relatively static over the last two decades, although hospital discharge rates have doubled. Emergency asthma self admission schemes developed in Edinburgh are increasing popular and these, along with nebulised bronchodilators in ambulances, may be beneficial.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1996

Multiple myeloma in north east Scotland: a review of incidence and survival over three decades.

STUDY OBJECTIVE: (1) To review the pattern of published world age-standardised registration rates for myeloma (ICD8 and ICD9 203) for the five Scottish regional cancer registries between 1973-77 and 1983-87. (2) To review the patterns of world age-standardised incidence and survival for myeloma in Grampian region over the time period 1960-89. DESIGN: Retrospective analysis of cancer registration data and linked mortality data. SETTING: The five Scottish regional cancer registries (East, North, North East, South East and West Scotland). PATIENTS: Incidence: a total of 405 patients with myeloma resident in Grampian region (153 diagnosed between 1960-69, 252 diagnosed between 1980-89 inclusive). Survival: a total of 420 patients with myeloma treated in Grampian hospitals between 1968 and 1987 inclusive. MEASUREMENTS AND MAIN RESULTS: On average, the world age-standardised registration rates for the five regional registries increased from 2.8 to 3.1 cases per 100,000 in males and from 1.8 to 2.4 per 100,000 in females between 1973-77 and 1983-87. No clearcut pattern in the trends for individual registries was evident for males but, in general, an increasing trend in female rates was observed for the registries with the lowest rates initially, whilst those with the highest initial rates increased only slightly or even fell. After age and sex standardisation, the annual incidence of myeloma in NE Scotland has increased by 20 per cent between 1960-69 and 1980-89, from 2.4 to 2.9 cases per 100,000 population per year with a disproportionate increase in older patients. Between the two time periods female rates remained stable or increased over all age groups while male rates fell for ages under 69 years and rose for ages above this, a pattern which was reflected in changes in the male:female ratio. The five year survival rate for all ages (14%) has not improved since 1968-72 similar to overall Scottish figures. In NE Scotland, younger patients appear to fare better, and older patients worse, compared with the overall Scottish experience. CONCLUSIONS: The increase in myeloma incidence may be due to a combination of improved ascertainment, especially in the elderly and a possible true increase in incidence in females, suggestive of increased exposure to an aetiological agent in the past. A formal year birth cohort analysis is required to confirm this finding. The overall prognosis for myeloma remains poor, especially for elderly patients and efforts to elucidate the aetiology must continue.

Age Distribution↗