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PubMed1992

Trends in mortality from stroke in Scotland, 1950-1986.

The Scottish Registrar General's Annual Reports have been used to study trends in mortality from stroke in Scotland during 1950-1986 in those aged 45 to 74. In 1950 the age-adjusted mortality rate was 347.4 per 100,000 population for men and 360.8 for women, falling to 199.6 for men and 155.8 for women in 1986. This downward trend has increased from 1976 for males. The average annual decline in age-adjusted mortality from stroke over the 37-year period was 4.0 per 100,000 in males and 5.5 in females. This reduction in death rates was proportionally higher for women compared with men in all age groups over 55 years. As with cardiovascular deaths, mortality from stroke was lower in the east than in the central region and west of Scotland. The reduction in mortality resulted in a substantial 'saving' of lives, estimated at 12,500 between 1980 and 1984.

Age Factors↗
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↗
PubMed2001

Partitioning the variation within the acid neutralizing capacity of surface waters in Scotland in relation to land cover, soil and atmospheric depositional factors.

A method of decomposing the variation in the acid neutralizing capacity (ANC) of surface waters in Scotland is described. Using national datasets, a series of variables relating to 703 catchments across Scotland is divided into three components representing (i) land cover, (ii) soil and (iii) atmospheric deposition/altitude. Redundancy analysis (RDA) and (partial) redundancy analysis are used to quantify the amount of variation in ANC uniquely attributable to each of these components, independent of the effects of the others. The variation accounted for by covarying combinations of these components is also determined. Approximately 55% of the total variation in ANC across the 703 sites is explained by the variables representing catchment characteristics and atmospheric deposition. Of this, 8.5%, 2.4% and 6.9% are uniquely attributable to the land cover, soil and deposition/altitude components, respectively. A further 38% of ANC variation is associated with the covariation between components, with 18% accounted for by the combination of all three. Approximately 45% of the variation in ANC remains unexplained. The results reflect the integrated nature of catchment processes and demonstrate, for these data, that it is a combination of land cover, soil and deposition and altitude factors which most explain variation in freshwater ANC level. The approach offers a tool with which to assess the sensitivity of surface waters to acid deposition at a regional scale and provides a way of identifying regional differences in catchment response to acid loading.

Acid Rain↗
PubMed2001

Interaction of nitrogen deposition and land use on soil and water quality in Scotland: issues of spatial variability and scale.

Over large areas of the Scottish uplands anthropogenic sulfur (S) deposition is declining in response to stringent national and European controls on S emissions. At the same time, however, the relative contribution of nitrogenous (N) compounds to the total anthropogenic deposition loading has increased. To investigate the significance of N deposition on the potential acidification of surface waters, national, regional, and catchment databases were developed to assess the relationships between N deposition, soil C/N ratios, land use and surface water NO3 concentrations. National classification schemes for land use and soils were used as only limited empirical data are available at such large spatial scales. Data were screened to eliminate areas where N inputs are dominated by non-atmospheric sources. From these screened datasets, it was apparent that areas with the highest risk of N leaching were situated predominantly in the upland areas of south-west and west Scotland (areas with low soil C/N ratios). At the regional scale, surface-water NO3 concentration in afforested catchments was negatively correlated with soil C/N ratios below 20. This relationship was not evident in moorland catchments, where NO3 leaching was strongly related to N deposition and the loch/catchment ratio, rather than the soil C/N ratio. Temporal trends of regional water quality highlighted as increasing loch NO3 concentrations between 1988 and 1996-1997, presumably reflecting an increase in N deposition, enhanced leaching losses from the terrestrial component of the catchment, or altered in-lake processes. The hydrochemical records for two catchments in NE Scotland (Lochnagar and Allt a Mharcaidh) highlight the importance of within catchment process in controlling the nitrogen response observed in surface waters. The potential mechanisms through which vegetation and soils may modify incoming deposition are discussed.

Acid Rain↗
PubMed2001

Effects of forest cover and topographic factors on TOC and associated metals at various scales in western Scotland.

Studies at the stream catchment scale have yielded inconclusive evidence of the effects of forest land use on the concentrations of organic carbon in drainage waters. The aim of this paper is to examine the effects of forests on carbon in drainage waters at the plot scale by comparing concentrations of total organic carbon (TOC) and associated metals in soil solutions from sites under forest and moorland vegetation. At an upland site in south-west Scotland soil solution TOC, aluminium and iron concentrations varied with land cover. Mean concentrations of all three determinands were at least 1.5 times greater under forest than under moorland, despite considerable spatial and temporal (seasonal) variability. TOC in soil solutions was also found to vary significantly with both relief and altitude. The altitude effect was particularly marked, with an increase of 26 mg x l(-1) x 100 m(-1) increase in altitude found at an upland site in west-central Scotland. There were no differences in chloride, sulphate or base cation concentrations between forest and moorland sites. Differences in aluminium concentrations could not be linked to atmospheric scavenging at the forest sites, but were closely linked to differences in TOC.

Altitude↗
PubMed2001

Water quality in Scotland: the view of the regulator.

Water quality in Scotland has progressively improved over the past 50 years as the environmental damage, which resulted from the industrial revolution, has been addressed. This paper provides an overview of current water quality in rivers, lochs, estuaries and coastal waters and describes the limited information available on groundwater. The main factors affecting water quality are reviewed, with sewage, diffuse agricultural pollution, acidification and urban drainage identified as the most important. Trends in pollution pressure and levels of investment in pollution control have been used to predict the condition of Scotland's surface water over the next 10 years. Major improvements are expected. However, progress will be slowed by the increased relative importance of diffuse sources of pollution, which are less amenable to legislative controls. Future changes in environmental monitoring are also expected to move the emphasis away from point source pollution. The current freshwater classification schemes are based upon a relatively narrow measure of water quality and are expected to expand to include a wider range of ecological parameters. This will result in an increase in the waters defined as impacted as the effects of other environmental pressures are taken into account. Finally the implications of these changes for the future management of the aquatic environment are assessed.

Environmental Monitoring↗
PubMed2002

Comparative study of the temporal evolution of atmospheric lead deposition in Scotland and eastern Canada using blanket peat bogs.

The temporal evolution of atmospheric lead deposition and its possible sources were assessed in eastern Canada and in western Scotland, using blanket peat bogs as geochemical archives. Short cores were taken from two remote sites located close to the sea. Significant lead enrichments in the upper layers at both sites reflect the increasing emission of lead into the atmosphere due to anthropogenic activities during the last century. At the Scottish site, a region under aeolian influence from Europe, anthropogenic derived lead could be recognized by the distinctive unradiogenic composition (206Pb/207Pb ratios down to approximately 1.115), being clearly different from the pre-industrial values (206Pb/207Pb approximately 1.166). In contrast, the lead pollution in eastern Canada (influenced by North American sources) is identified by a more radiogenic lead isotope composition (206Pb/207Pb ratios up to approximately 1.199) compared to preindustrial values (206Pb/207Pb approximately 1.161). Emission inventories and isotope characteristics suggest that industrial (coal burning, mining) and traffic (leaded gasoline) outputs are the most likely sources during the first and the second half of the 20th century, respectively, in both, western Scotland and eastern Canada alike. The Scottish record is in line with previous studies of past atmospheric lead deposition. However, the Canadian deposit suggests that the wind derived, pre-industrial lead, is less radiogenic as previously implied using sediment archives. These results are thus the first to report pre-industrial lead isotope ratios and concentrations of atmospheric derived aerosols in North America.

Air Pollutants↗
PubMed2002

Hydrology of peat-forming wetlands in Scotland.

Peatlands cover approximately 14% of Scotland, although only part of this area is active (peat-forming) mire. Mires are important for the biodiversity of the specialist plant and animal communities they support. Study of mire ecosystems has revealed intimate relationships between their organic components and water, which mean that it is impossible to understand their ecology without considering hydrology. Whilst ecohydrological studies have concentrated on the internal functioning of mires, the insights gained are relevant to runoff generation in peat-covered river catchments. This paper reviews our knowledge of processes occurring in mires and relates these to wider catchment hydrology, on the basis of published information and recent research in Scotland. The influence of different types of land management is considered, and it emerges that mire is most effective in delaying storm run-off, in preventing soil erosion and in retaining inorganic nutrients when it is undrained; although there can be adverse effects on water quality under certain conditions. In the context of global warming, mire ecosystems are sensitive but at the same time robust to climate change, and thus contain archives of climatic data for the Holocene. Moreover, peatlands store significant quantities of carbon, and influence directly the concentrations of greenhouse gases in the atmosphere. Various issues related to conservation and restoration of peatland biodiversity have been addressed constructively in recent decades, although approaches and objectives are not always consistent between sites. These are reviewed, and some outstanding issues and research needs are identified.

Ecosystem↗
PubMed2003

Drug-related deaths by region, sex, and age group per 100 injecting drug users in Scotland, 2000-01.

BACKGROUND: In 2000 and 2001, there were 292 and 332 drug-related deaths in Scotland, respectively. Of the 332 people who died in 2001, 65 were of female sex, 80 were younger than 25 years, and 112 were older than 34 years. We assessed the effect of region, sex, and age group on drug-related deaths in Scotland per 100 injecting drug users. METHODS: We used published regional estimates of current injecting drug users (n=22805), their sex (30% female) and age distribution (8% older than 34 years in mid-1990s), or corresponding data for problem drug users (21% older than 34 years in 2000) to compare observed with expected drug-related deaths by region, sex, and age group per 1000 population or per 100 injecting drug users. FINDINGS: Regional population-based expectations fitted poorly to observed drug-related deaths, but those based on injecting drug users fitted tolerably. Drug-related deaths in 2001 per 100 injecting drug users were significantly lower in female (0.9 [95% CI 0.6-1.1]) than in male drug users (1.5; 1.3-1.7). They were between two and six times more frequent per 100 injecting drug users older than 34 years than younger than 25 years, depending on whether current injecting drug users' age distribution was assumed to be the same as problem drug users' or as injecting drug users' in the mid-1990s (2.1 [1.7-2.5] or 5.3 [4.3-6.3], respectively). INTERPRETATION: Older and male injecting drug users were at highest risk of drug-related death. Injecting drug users' age distribution should be assessed and compared across countries.

Adolescent↗
PubMed2003

Pneumococcal bacteraemia: clinical and microbiological epidemiology in Dundee, Scotland.

OBJECTIVE: To report the incidence of drug resistant Streptococcus pneumoniae isolated from blood culture in Dundee, Scotland. We shall also review the clinical and laboratory findings in these cases. METHODS: A retrospective review was undertaken of all cases of S. pneumoniae bacteraemia identified in our local area during a three year period from August 1st, 1997 to July 31st, 2000 (107 cases.) Data was obtained from patient medical records, blood culture reports and results of Stoke's disk testing. Many organisms were also sent to the Scottish Meningococcus and Pneumococcus Reference Laboratory for serogrouping and determination of the minimum inhibitory concentration of common antibiotics. RESULTS: Annual incidence of bacteraemia was approximately 15.9-17.8 per 100000 population. Mortality was 33% (34 and 30% for those with pneumonia or meningitis, respectively). No relationship was seen between patient age and overall mortality. Factors relating to increased mortality were a high respiratory rate (p=0.01), high blood urea level (p=0.05) and the presence of confusion (p<0.01) on admission to hospital. The incidence of penicillin resistant S. pneumoniae was 7%, all of these isolates having low level resistance. Macrolide resistance was 8%. Neither were found to be increasing over the three year period. The most common serogroups were 23 (18%) and 14 (12%). CONCLUSIONS: The incidence of penicillin resistant S. pneumoniae isolated from blood culture in Dundee, Scotland, is similar to the UK average and did not appear to be rising between 1997 and 2000.

Adolescent↗
PubMed1999

Epidemiology and outcome of HIV infection in North-East Scotland (1985-1997).

OBJECTIVE: to assess the epidemiology of HIV infection in North-East Scotland. METHODS: retrospective casenote review of all HIV-infected patients who have had contact with the Infection Unit in Aberdeen. RESULTS: one hundred and forty-two HIV-infected patients were treated between April 1985 and December 1997. The risk behaviour related to the acquisition of the HIV infection was: 56 (39%) homosexually infected, 45 (32%) heterosexually-infected, 34 (24%) injecting drug users (IDUs), and seven (5%) blood products or not known. Sixteen of the 45 (36%) heterosexually-infected patients were native to Africa and 16 of the 34 (31%) IDUs were prisoners in Peterhead prison at the time of referral. Fifty-two (37%) of the cohort continue to attend the Infection Unit, 41 (29%) have relocated, 40 (28%) have died and nine (6%) have been lost to follow-up. The ratio of heterosexual:homosexual men:IDUs changed significantly between the first 7 years (12:21:25) and the second 6 years (33:35:9) of the review, with significantly more patients being infected through heterosexual contact and fewer infected by IDU in the second period-P<0.001. The median AIDS survival was 17 months. Survival was significantly longer in those patients who took anti-retroviral therapy (median = 20 months) than in the patients who opted not to take anti-retroviral therapy (median = 11 months)-P<0.01. CONCLUSIONS: Although homosexual contact represents the commonest risk group for HIV infection in this region, the number of heterosexually-infected patients has increased significantly in the last 5 years. Temporary residents account for one-third of the HIV-infected population cared for in NE Scotland. Almost half of those lost to follow-up have returned to Africa or been released from prison. The introduction of anti-retroviral therapy has resulted in a dramatic improvement in AIDS survival in our cohort as it has done elsewhere.

Africa↗
PubMed2001

A survey of the prevalence of Escherichia coli O157 in raw meats, raw cow's milk and raw-milk cheeses in south-east Scotland.

2429 samples of foodstuffs were examined for the presence of verocytotoxigenic Escherichia coli O157 (VTEC O157) by means of immunomagnetic separation (IMS) over a 2-year period commencing April 1997. Specimens comprised 1190 raw meats, 500 raw milks and 739 raw-milk cheeses. The meat and cheese samples were purchased from retail premises in south-east Scotland; raw milk samples were obtained directly from farms. In addition, total E. coli counts were performed on milk and cheese samples, and the pH of cheese specimens measured. The water activity (Aw) was also measured for a representative sample of each cheese type, and for all of the samples with high levels of E. coli. VTEC O157 was isolated from two samples of beef burger, both manufactured on the premises of the same butchers shop. Control studies with artificially inoculated foodstuffs demonstrated a sensitivity of detection of < 5 organisms 25 g(-1). These findings, which contrast with the results of similar studies elsewhere in the UK, suggest that other sources of infection may be important in explaining the high rates of infection with this organism in south-east Scotland.

Animals↗
PubMed1992

Systems of midwifery care in use in Scotland.

A survey was undertaken to identify the different systems of midwifery care in use in hospital and community settings in Scotland. The 53 units which responded provided 90% of the maternity care in Scotland. Of the 53 units, the 28 integrated units undertook 83% of Scottish births and were more likely than the non-integrated units to have implemented systems designed to reduce fragmentation of care. Nearly a fifth of units had five different systems of care in operation. More than half the units had at least one of the following systems of care in operation or under planning: individualised care plans; 'patient allocation'; DOMINO schemes; nursing/midwifery process or model; and team midwifery. The most frequently used system was planning individualised care (88% of the units). 'Patient allocation', nursing/midwifery process or model and the DOMINO scheme were in over 60% of the units. The least used system was team midwifery, which was in operation in 21% of the units and being planned for a further 30%. The use of the different systems in combination within a number of units demonstrates that approaches to the objective of continuity of care are complex. There is a need for further research into continuity of care as this is a commonly cited advantage of all five systems of care.

Data Collection↗
PubMed1997

Chinese zuo yuezi (sitting in for the first month of the postnatal period) in Scotland.

OBJECTIVE: To examine how Chinese women experience postnatal care in a Scottish setting, their beliefs, needs and experience, and why any differences exist. The aim is to bring the knowledge forward and to improve these women's childbearing experience. DESIGN: a qualitative comparative approach. SETTING: maternity units in Scotland. PARTICIPANTS: ten Chinese and ten Scottish women, ten health workers, five relatives, five Chinese women's friends, and five Scottish women's friends, plus two groups discussions of four and six Chinese discussants, and one group discussion with four Scottish mothers and a health worker. METHOD: four stage semi-structured interviews with the two comparison groups of ten Chinese and ten Scottish women, and non-structured interviews/talks/discussions with ten health workers, ten women, five relatives and ten friends. FINDINGS: zuo yuezi is a popular integrated set of postnatal practices for Chinese mothers, not only in China, but also in Scotland, in their convalescence after giving birth. This traditional postnatal behaviour is embedded in culture. It is used to facilitate the physical recovery of the mothers, to prevent chronic illness, and also to strengthen their intra-family relationships. CONCLUSION: zuo yuezi serves as a physical convalescence, a preventative measure, a social sanction to rest, a consolation, and a prompt for Chinese women to concentrate on their baby and their role of breast feeding, as well as an occasion to strengthen the intra-family tie, especially between the woman and her own mother or mother-in-law. This practice has a direct bearing upon the psychological well-being of Chinese women postnatally and in their future life. This suggests that these puerperal practices and the custom deserve the cognitive recognition of midwives, so that they can be aware of and respect the indigenous beliefs and practices that link the events of childbearing, the health status of women, and family relationships in order to provide better maternity care for this group of women.

Adult↗
PubMed1999

The use of magnification in general dental practice in Scotland--a survey report.

OBJECTIVES: This study had two aims, first, to quantify the level of the use of magnification in general dental practice in Scotland and second, to determine the current and potential areas of clinical use of magnification by general dental practitioners. METHODS: A questionnaire was sent to all general dental practitioners in Scotland with a Health Board list number (n = 1790). The questionnaire asked the practitioners about their experience of magnification and their opinions on possible areas for clinical use. An information sheet and a prepaid envelope were included with the questionnaire. RESULTS: One thousand two hundred and eighty (72%) of the dentists replied to the questionnaire. Nine percent of the respondents routinely used magnification. The level of routine use of magnification by practitioners increased with time since qualification. The suggested areas of clinical use of magnification by all the respondents were crown and bridge work, diagnosis and radiography. The routine users of magnification had a more positive view of magnification than non-users. CONCLUSIONS: Routine use of magnification was associated with the length of time the practitioner had been qualified and the attendance at a course at which magnification was discussed. The perceived uses of magnification depended on the experience of the practitioner with magnification. It was considered suitable for all clinical procedures except orthodontics and prosthodontics.

Attitude of Health Personnel↗
PubMed2000

Reasons for tooth extraction in Scotland.

OBJECTIVES: A 1984 study investigated the reasons underlying the extraction of teeth in Scotland. The survey described in this paper, used a similar methodology and aimed to determine the reasons for the extraction of permanent teeth by general dental practitioners and investigate changes in the influences on tooth extraction over a 10 year period. METHODS: During a 1 week period in November 1994, 139 general dental practitioners working throughout Scotland, recorded the reasons for all permanent tooth extractions. RESULTS: A total of 917 permanent teeth were extracted from 613 patients, the reason for extraction being stated as dental caries (51%), periodontal disease (21%), orthodontics (11%) and failed endodontics (4%). Trauma, pericoronitis and other reasons accounted for 5.5% of extractions whilst, in 7.5% of cases, patients requested extraction in preference to other treatments. The proportion of extractions attributed to periodontal disease increased from age 31-60 years, but declined thereafter. CONCLUSIONS: Comparing the results with those obtained in the 1984 study, whilst the mean number of teeth extracted by each practitioner had reduced, the overall relative contribution of different reasons for extraction was similar.

Adolescent↗
PubMed2001

Flame burn admissions and fire fatalities in Scotland with particular reference to the Strathclyde (Glasgow) region, and their prevention.

Scotland has the highest rate of fire fatalities in the UK. Nearly 50% of the population and fire deaths in Scotland are in the Strathclyde region. The data from the burns unit at Glasgow Royal Infirmary were studied to find the number of admissions due to flame burns and see how it compared with the fire deaths. During 1981-1993, amongst 2771 admissions to the burns unit, 1181 (43%) were due to flame burns and out of these flame burn victims, 69% were adults, 16% elderly and 15% children. The distribution of cases according to the total body surface area (TBSA) involvement was 866 (73%) with 1-15%, 165 (14%) with 16-30%, and 150 (13%) with > or =31% TBSA burns. The annual number of flame burn admissions declined during 1981-1993. In the Glasgow region 50% of the domestic fires leading to non-fatal burns or to death were started by misuse of smoking materials. Chip pan fires were responsible for 8% of admissions to the burns unit. The annual number of fire fatalities when reviewed for a longer period 1973-1995 also showed a decreasing trend. Further educational and legislative measures to prevent flame burns are discussed.

Adolescent↗