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PubMed1994

Declining incidence of paediatric burns in Scotland: a review of 1114 children with burns treated as inpatients and outpatients in a regional centre.

This retrospective study of paediatric burns in the Lothian region involved a review of 1114 case notes of children up to the age of 12 years, treated for burns as inpatients and outpatients, during a 3-year period between 1988 and 1990. There were more boys than girls and 79 per cent were below 5 years of age. 71.5 per cent were treated as outpatients only, whereas 28.5 per cent were admitted. The Lothian region had the highest incidence of burns of children in Scotland. There has been a statistically significant downward linear trend in burn rates and admissions in Scotland during the 20 years but in this hospital burns admissions have significantly diminished only since 1987. The number of flame burns has declined and a high proportion of the victims were scalded. Efforts need to be made to reduce the large number of scalds by educational and legislative measures.

Adolescent↗
PubMed2001

Drug related deaths in the Strathclyde region of Scotland, 1995-1998.

The misuse of drugs, both illicit and prescribed has increased dramatically in the west of Scotland over the last few decades. Consequently, the number of drug related deaths has risen as a direct result. Since, discrepancies exist between data collected by the Department of Forensic Medicine and Science, University of Glasgow and official statistics, this project, was funded to investigate all known drug related deaths that occurred within the Strathclyde region of Scotland in an effort to improve the accuracy of statistics and the dissemination of information pertaining to them. Changes in medical treatment, legislation and patterns of drug taking were noted and the effects of these on the year-by-year death tolls evaluated.

Adolescent↗
PubMed2003

Life-years gained from coronary heart disease mortality reduction in Scotland: prevention or treatment?

Coronary Heart Disease (CHD) death rates have fallen considerably in many countries. We estimated the life-years-gained (LYG) in Scotland between 1975 and 1994 attributable to cardiology treatments, and population reductions in major CHD risk factors, using a previously validated mortality model. This combines published effectiveness data with information on uptake of CHD treatments; risk factor trends; and median survival by age and sex. Compared with 1975, there were 4,536 fewer CHD deaths in 1994, resulting in approximately 48,016 LYG among those aged 45-84 (maximum estimate 53,317; minimum estimate 36,867). Medical and surgical treatments for CHD patients gained approximately 12,025 life-years; the largest contribution coming from pharmacologic secondary prevention. Population reductions in major risk factors (smoking, cholesterol, and blood pressure) accounted for some 35,991 LYG, reductions in smoking accounted for over 50% of this. Modern cardiologic treatments gained many thousands of life-years in Scotland, but modest reductions in risk factors gained almost three times as many life-years.

Age Distribution↗
PubMed1998

The management of pulmonary tuberculosis in adults notified in Scotland in 1993.

The management of pulmonary tuberculosis (TB) in Scotland in 1993 was studied by asking the physicians responsible for all 321 adult cases of the disease notified that year to complete a standardized questionnaire relating to drug treatment and bacteriology. The response rate to the questionnaire was 100%. Isoniazid and rifampicin were used together in initial therapy in 98.4% of cases, while pyrazinamide was prescribed in 90.3% of cases, broadly in keeping with existing treatment guidelines. However, considerable variability was observed both in the drug regimens employed, and in the duration of initial and continuation phases of chemotherapy. Treatment regimens were therefore frequently at variance with published recommendations. Among patients prescribed drug regimens other than those recommended satisfactory completion of therapy was less common. Microbiological confirmation was provided for 84% of cases in which clinical samples were submitted. However, in approximately 11% of cases, no clinical samples were submitted. Closer adherence to existing treatment guidelines and more rigorous pursuit of microbiological confirmation should further improve the overall management of pulmonary TB in Scotland.

Adolescent↗
PubMed2002

Changes in public awareness of, attitudes to, and use of complementary therapy in North East Scotland: surveys in 1993 and 1999.

OBJECTIVE: To assess changes in awareness of, use of, attitudes to, and opinions about complementary and alternative medicine (CAM) amongst residents of North East Scotland and to obtain details about CAM use from respondents. STUDY DESIGN: Population survey carried out in 1999, 6 years after the initial study. Postal survey to 800 people to examine eight CAMs; acupuncture, aromatherapy, chiropractic, herbalism, homeopathy, hypnotherapy, osteopathy, and reflexology. RESULTS: A total of 432/800 (54%) responded, of whom 175 (41%) had used at least one type of CAM compared to 29% in 1993. Increases in use were statistically significant for aromatherapy (18% versus 9%), acupuncture (10% versus 6%) and reflexology (9% versus 3%). A greater proportion of 1999 respondents thought CAM should be available on the NHS but a smaller proportion of respondents had concerns about using CAM (25% in 1993 and 20% in 1999). Overall concerns about effectiveness of therapies had increased from 36 to 45%, but fewer individuals were concerned about the cost of therapy in the 1999 survey (52% in 1993 to 22% in 1999). A total of 175 individuals provided details about one CAM they had used. The self-reported primary reasons for using CAM were relief of pain due to headaches or musculoskeletal problems, and for relaxation and relief of stress. The majority of CAM was therapist administered (103/166) as opposed to a bought product. Effectiveness ratings were self-reported but overall 80/166 found CAM very effective and 62/166 partially effective. A total of 65% had consulted their GP about their health problem before using CAM, 59/157 indicated their GP knew they were using CAM and of these, 14 indicated their GP was administering the therapy. CONCLUSIONS: The study has provided further baseline data on which to assess trends in CAM use and highlighted issues for patients and the NHS about the use of CAM to relieve health problems. Results indicate a greater proportion of the population of North East Scotland are both aware of and using CAM to relieve health problems. More research into the implications for the NHS of concurrent use of CAM with conventional medicine is required.

Adult↗
PubMed1998

Variation in management of intermittent claudication by vascular surgeons in Scotland. Scottish Vascular Audit Group [corrected].

OBJECTIVES: The principal aim was to determine the extent to which intended and actual management varied among vascular surgeons. DESIGN: Prospective survey. METHODS: A nationwide survey of initial management of, and determination of subsequent surgical management in, 1180 patients with a diagnosis of intermittent claudication made by 28 vascular surgeons was carried out in Scotland. RESULTS: The proportion of patients considered for conservative management varied between consultants from 10-83% (mean 42%, S.D. 16%). The proportion considered for angiography varied from 13-80% (mean 46%, S.D. 14%). For surgery, the range was 4-68% (mean 37%, S.D. 14%) and for angioplasty the range was 13-90% (mean 49%, S.D. 19%). All differences in management intention between consultants were significant (p < 0.001). The differences between consultants in terms of treatment actually received within 6 months were less striking but still significant (p < 0.05). All consultants actually managed more patients conservatively than they had originally intended, but there was poor correlation between intended and actual practice. CONCLUSIONS: In Scotland the variations between surgeons in both intended and actual management are substantial. Large scale randomised controlled trials of treatment of claudication are urgently required to make clear the best treatment strategies.

Adult↗
PubMed2003

Predicting smoking behaviour in census output areas across Scotland.

Spatially disaggregated surveys of smoking behaviour are rare and hence estimating the geography of the incidence of smoking is difficult. The main aim of this study is to develop a technique for estimating smoking probability for different age/sex groups in small areas across the whole of Scotland using information on smoking behaviour from the Scottish Household Survey. This is useful not only in its own right, but as an aid to studies of geographical variations in diseases such as lung cancer that, as a first step, need to control for smoking behaviour. The method developed uses individual-level characteristics from the Scottish Household Survey combined with a set of output area and pseudo-postcode sector measures from the 1991 census to model the probability of smoking. The parameters from this model are then used to make smoking predictions by age and sex for output areas across Scotland. This is the first time that such geographically detailed estimates of smoking have been made available.

Adolescent↗
PubMed2001

XML for electronic clinical communications in Scotland.

This paper describes the use of extensible markup language (XML) for electronic clinical communications in Scotland. It gives the results of the first UK project to send and receive discharge letters using XML. This pilot had the advantage of transferring readable clinical information between computer systems and giving the receiving GP choice of decoding and saving clinical and administrative data into his practice system. A number of existing clinical systems and a variety of written documents were studied. Existing trial standards, including the NHS EDIFACT, HL7v2 and CEN standard ENV 13606 were taken into consideration. The project worked with the receiving GP system supplier, GPASS, and the NHS Scotland Information and Statistics Division in defining the document type definition (DTD) for the pilot DTD. GPASS undertook production of a module for their system to parse the XML messages into the patient record on the GP system. The system allows the GP to read and print the original document and modify the content prior to storing in the practice system. SMTP e-mail messages were used for the pilot. Resulting messages were parsed into the GP system and validated by a variety of GP users. Currently there is a large scale program to develop XML Schema and web browser based communications of referrals, discharge and laboratory orders and reports.

Computer Communication Networks↗
PubMed2004

Management of congenital talipes equino varus in Scotland: a nationwide audit.

The Scottish Talipes Register is a record of all newly diagnosed cases of idiopathic congenital talipes equinovarus (CTEV) in Scotland over a four.year period. Two hundred and sixteen children were entered into the register, which recorded initial management and all subsequent interventions, both non-operative and operative. The data, therefore, represent a record of the different management regimens used within Scotland highlighting the variations in duration of conservative management and variations in surgical intervention following different methods of conservative management.

Casts, Surgical↗
PubMed2005

Children's surgery performed by adult general surgeons in Scotland: the present and future.

OBJECTIVE: The aim of this study was to determine the extent and the future of paediatric surgery performed in Scotland outside of the designated surgical paediatric centres. MATERIALS AND METHODS: An anonymous questionnaire was sent to all 111 Scottish members of the Association of Surgeons of Great Britain and Ireland. There was a response rate of 69%. RESULTS: Overall, 45% of responders operated on children. This was independent of the surgeon's age but was related to the type of hospital that the surgeon worked in. Eighty-four per cent of responders had a lower age limit under which they would not operate and 94% stated that there were specific circumstances where they would not operate. A mean of 18.5 elective procedures (range 0-250, median two) and six emergency procedures (range 0-30, median five) were carried out by each surgeon operating on children under the age of five per annum. Only 13% of responders thought that their successor would operate on children. CONCLUSIONS: Non-specialist paediatric surgery in Scotland is currently provided by a significant number of surgeons whose successors will not continue to provide a comparative paediatric service. This has implications for local provision of care, emergency management and capacity of existing children's hospitals in the future.

Adult↗
PubMed1974

Epidemic keratoconjunctivitis in the West of Scotland, 1967-72.

Outbreaks of epidemic keratoconjunctivitis have occurred among workers in shipyards and other industrial concerns in the West of Scotland in 1956, 1967 and 1971-72. In the most recent episode 220 persons were known to be affected and those mainly involved were shipyard personnel working on the open decks of ships under construction; only a few non-industrial workers were affected. As in previous outbreaks adenovirus type 8 was shown to be the causal organism. It is likely that spread of the virus was probably facilitated in some of the patients by such procedures as first aid measures to remove foreign bodies from the eye. A survey of the family contacts of those affected in 1971-72 revealed that only 2% were secondarily infected. This was probably due to propaganda measures to discourage the use of communal face towels, etc.Despite close virological surveillance over a period of 6 years of patients attending opthalmic clinics in the West of Scotland, there is as yet no clue to the whereabouts of adenovirus type 8 during interepidemic periods. It is suggested that travellers might be responsible for the introduction of the infection into an area.

Adenoviridae↗
PubMed1985

Campylobacter infection in urban and rural populations in Scotland.

A review of campylobacter infection in Scotland over five years (1978-82), during which 7808 human isolates were recorded (mean annual isolation rate of 30 per 100000), revealed differences in the epidemiology of the disease between rural and urban populations which were not apparent in the national data. The incidence of infection in the two rural areas studied was greatest in the early months of the year, whereas that in the two urban areas showed a third-quarter predominance. In both urban and rural populations, age-specific infection rates were highest in children less than 5 years old, but this trend was more pronounced in rural than urban populations. Conversely, secondary peaks in age-specific infection rates observed in young adults were more pronounced in the urban than rural populations. It is postulated that rural children were being infected by campylobacters at an early age by drinking contaminated raw milk which was not normally available to city residents. The lower incidence in adults in the rural populations is interpreted as indicating more widespread immunity, resulting from greater exposure to infection during childhood. The effect of compulsory heat treatment of milk sold in Scotland, introduced in August 1983, is currently being studied.

Adolescent↗
PubMed1984

Meningococcal infections in Scotland 1972-82.

Strains of Neisseria meningitidis isolated from patients with meningitis or septicaemia without meningitis in Scotland during the years 1972-82 have been reviewed together with details of the age, sex, disease and outcome of the patients from whom they were isolated. A total of 1185 strains were isolated, of which 927 were examined at the Meningococcal Reference Laboratory (Scotland): 19.3% were of serogroup A, 63% of group B, 9.6% of group C, 6% of W135 and 1.6% of other groups. Non-groupable strains were rare. Disease was most common in the first years of life but there was a difference in the age distribution of disease due to the different serogroups, the proportion of disease due to group B being smaller in adults than that due to other serogroups. The overall mortality in meningitis was 7.5% and in septicaemia was 20.6%, although there were differences between the rates for the various serogroups. The serogroup distribution differed in disease as opposed to meningococci isolated from carriers although group B strains were predominant in both series. Overall, approximately 15% of strains were resistant to sulphadiazine, the proportion of resistant group A strains being higher than that of other serogroups.

Adolescent↗
PubMed1999

Coagulation studies in patients admitted with epistaxis--current practice in Scotland.

Epistaxis remains the most common ENT emergency. The use of coagulation studies in Scotland to manage these patients was investigated to determine current practice. The study took the form of a postal questionnaire sent to all practising ENT consultants and a telephone survey of ENT senior house officers working in Scotland. Of the 60 questionnaires circulated amongst consultants, 55 responses were received (92 per cent). Thirty-eight consultants (70 per cent) indicated that they did not routinely request a coagulation screen for their patients, however, 30 per cent (16) did. Forty-three of the 45 junior staff were available for interview, 22 (51 per cent) of whom routinely requested coagulation studies. While the majority of consultants did not request routine coagulation studies, there did not appear to be any consensus among the junior staff. Although there is a paucity of scientific information with regard to this aspect of epistaxis patient management, there is support in the literature for targeted rather than blanket testing. There is perhaps a need to address this issue within individual departments, to achieve uniformity of practice, and to improve communication between junior and senior staff.

Blood Coagulation↗
PubMed1995

Clonal structure of invasive Streptococcus pyogenes in Northern Scotland.

We have used molecular techniques to characterize 51 group A streptococci from Scotland and 17 'serious disease' isolates from other countries, in order to establish the clonal structure of invasive Streptococcus pyogenes strains circulating between 1986 and 1993. Strains were grouped by restriction endonuclease analysis, pulsed field gel electrophoresis and ribotyping patterns, and were examined for the presence of alleles of the speA gene by polymerase chain reaction and DNA sequence analysis. Serious and fatal infections in Scotland were caused by several clones. One clone (9 of 51 strains) was M type 1 and possessed the speA gene allele 2. This was the clone previously identified as causing severe infection in the USA. Another clone (5 of 51 strains) was M type 3 and had speA gene allele 3. In view of the clear association of more than one clone with severe, invasive and fatal infections, horizontal gene exchange between genotypes merits further investigation.

Base Sequence↗
PubMed2002

Influenza and pneumococcal vaccine distribution and use in primary care and hospital settings in Scotland: coverage, practice and policies.

A survey of the coverage, distribution and the factors associated with use of influenza and pneumococcal vaccines among general practitioners (GPs) in primary care and in hospital settings was carried out in 53 general practices in Scotland taking part in the 'Continuous Morbidity Recording' (CMR) programme. The annual vaccine distribution increased substantially among 53 general practices from 1993 to 1999 and in Scotland as a whole from 1984 to 1999. From the questionnaire, overall coverage was 43% (95% CI 38-48) for influenza vaccine in the 2000-1 season and 13% (95% CI 9-16) for pneumococcal vaccine in the last 5 year period, in high-risk patients recommended for these vaccines by the Department of Health (DoH). Influenza vaccine coverage was highest in the elderly (65 years of age and above) at 62% (95% CI 59-74). Although pneumococcal vaccination is not currently recommended for all elderly, coverage of this vaccine was also higher in this group (22%, 95% CI 16-29). In the majority of patients (influenza vaccine, 98% and pneumococcal vaccine, 94%), vaccination was carried out in general practice. Only 2% of patients had received pneumococcal vaccination in a hospital setting. The level of influenza and pneumococcal vaccination varied with the level of deprivation. Most GPs considered that the responsibility for influenza and pneumococcal vaccination lay with them. Forty-five percent of GPs reported having a written policy with set target for influenza vaccination and 11% for pneumococcal vaccination.

Aged↗
PubMed2004

Human campylobacteriosis in Scotland: seasonality, regional trends and bursts of infection.

Fourier time-series models were constructed to study regional and national seasonality of human campylobacteriosis in Scotland between 1997 and 2001. Strong seasonality was demonstrated with an annual peak of reported cases in late June to early July. The prominence of this peak varied between regions, which was exemplified for the two major population centres: Lothian, with mixed urban/rural population, had a more prominent peak than Greater Glasgow, which has a predominantly urban population. No significant trend of annual cases of campylobacteriosis was found nationally and Fourier models successfully predicted the seasonal pattern of national and regional cases in 2002. During the period studied, the Fourier model identified >20 bursts of infection (potential outbreaks). Multi-regional bursts were also identified in the summers of 1998 and 2000 - the latter comprising the vast majority of the regions in Scotland, which could suggest a national outbreak.

Campylobacter Infections↗
PubMed2005

Severe illness and death among injecting drug users in Scotland: a case-control study.

Between April and September 2000, 60 injecting drug users in Scotland died or were hospitalized with severe illness. Laboratory investigations suggested that Clostridium novyi and other bacteria were important aetiological agents. To determine associated environmental/behavioural factors a case-control study was undertaken with 19 'definite' and 32 'probable' cases in Glasgow, Scotland. For every deceased case (n=19), up to three proxy individuals were interviewed. Three controls were identified for each case. Multivariate logistic regression analyses compared (i) all cases and controls; (ii) definite cases and matched controls; (iii) probable cases and matched controls. In all three analyses injecting into muscle or skin and injecting most of the time with a filter used by someone else were the variables most strongly associated with illness. Comparing only muscle-injecting cases and controls, cases were significantly more likely to have injected larger amounts of heroin per average injection than were controls. The findings make an important epidemiological contribution to the understanding of the public health and clinical implications of the contamination of illicit drugs by histotoxic clostridia.

Adult↗