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PubMed2001

Trends in hospital activity, morbidity and case fatality related to atrial fibrillation in Scotland, 1986--1996.

AIMS: Atrial fibrillation is a common and important cause of cardiovascular morbidity and mortality that may become more prevalent due to an ageing population and more prolonged exposure to predisposing cardiovascular disease states. This study examines recent trends in hospitalizations related to atrial fibrillation in Scotland. METHODS AND RESULTS: Scotland (population 5.1 million) has a well described system for recording hospitalization data. All hospital discharges (and death) can be linked for each individual patient. We examined the period 1986--1996, during which time a total of 103,085 hospitalizations with a principal or secondary diagnosis of atrial fibrillation were recorded. The number of hospitalizations with a principal diagnosis of atrial fibrillation increased threefold from 1869 in 1986 to 5757 in 1996; the number with a secondary diagnosis rose from 3577 to 11,522. Similar increases were seen in the number of patients hospitalized, in those having a 'first-ever' hospitalization and in population hospitalization rates overall. The average age of patients rose, in men from 63.8 (SD 13.2) to 65.0 (13.2) years and in women from 72.2 (12.2) to 73.2 (11.4) years. The proportion of those aged >75 years rose from 33% to 35% in men and from 56% to 60% in women. Average length of stay and case fatality fell during this period, but, because of the overall increase in hospitalizations, atrial fibrillation contributed to a growing proportion of cardiovascular-related bed-days utilized (from 18% to 37% with atrial fibrillation coded in any diagnostic position). CONCLUSION: The number of hospitalizations for atrial fibrillation has increased dramatically (two- to threefold) in recent years. These findings may be due to a real increase in atrial fibrillation prevalence, changing medical practice (e.g. coding or admission thresholds) or both. Consequently, the public health burden of atrial fibrillation is enormous. Moreover, the observed increase in atrial fibrillation-related hospital activity shows no sign of abating.

Age Distribution↗
PubMed2001

The extent and nature of emergency nurse practitioner services in Scotland.

Emergency Nurse Practitioners (ENPs) are being used in an increasing proportion of A&E departments across England and Wales. This paper reports the findings of a postal survey sent to all (94) A&E departments in Scotland including the smaller GP run units. The aim of the study was to document the extent and nature of ENP services in Scotland. Nurses were found to be practising as ENPs in 47% of Scottish A&E departments. The majority (70%) of nurses practising as ENPs had been educated for the role on courses for ENPs. Nurses working as ENPs were being paid at all grades ranging from the lowest grade for a staff nurse (D-grade) through to H-grade. ENPs are practising in all types of A&E department. Most ENPs have been formally trained for the role, however huge variation exists in educational preparation and in remuneration for this expanded nursing role.

Emergency Nursing↗
PubMed2001

Paternal occupational contact level and childhood leukaemia in rural Scotland: a case-control study.

In a national Scottish study of 809 cases of leukaemia and non-Hodgkins lymphoma diagnosed in 1950-89 among children aged 0-4 years who were born in Scotland, together with 2363 matched population controls, we investigated one aspect of the infective hypothesis. This concerns whether in rural areas (where the prevalence of susceptible individuals is likely to be higher) the risk is greater among the young children of men whose work involves contacts with many different people, particularly children, as noted in certain childhood infections. A positive trend was found in rural areas across 3 levels of increasing paternal occupational contact (as recorded at birth) by each of 2 previously defined classifications; no such effect was found in urban areas. The rural trend was more marked in that part of the study period with greater population mixing, but the difference from the period with less mixing was not itself significant, leaving open whether these rural findings reflect the extreme isolation of much of rural Scotland, or the effects in such areas of a degree of population mixing. In marked contrast, among the 850 cases and 2492 controls aged 5-14, those in rural areas in the higher population mixing period showed a significantly decreasing trend with increasing paternal occupational contact level. This would be consistent with immunity produced either by earlier infection at ages 0-4 years, or directly by low doses of the infective agent that were largely immunizing at these older ages. The findings overall provide further support for infection underlying childhood leukaemia and for the role of adults.

Adolescent↗
PubMed2000

Cord-care practice in Scotland.

OBJECTIVE: To identify the range of policies, practices and rationale for umbilical-cord stump care in the NHS in Scotland. DESIGN: A postal questionnaire survey completed in two stages. The first stage elicited the views of Heads of Midwifery/Senior Midwives, and the second stage the views of midwives, enrolled nurses and nursery nurses. SETTING: NHS units in Scotland providing intrapartum care. They were separated into large and small units with small units having < or = 1000 deliveries per year (n = 178), and large units > 1000 deliveries per year (n = 300). PARTICIPANTS: The Heads of Midwifery/Senior Midwives from the 51 units were invited to participate in the study and 49 (96.1%) replied. In stage two 512 maternity unit employees were sent questionnaires and 390 (76.2%) replied. These were six enrolled nurses, 20 nursery nurses and 360 midwives and four respondents of unspecified occupation. MEASUREMENTS: The existence of cord-care policies and their rationale. FINDINGS: About half of the units that responded had a written policy. Large units were four times more likely than small units to have a written policy. Both managers and staff reported that the most common policy/agreed practice was no specific care (cord observed and only cleaned if soiled). Where a written policy existed, less than one-half of the Heads of Midwifery/Senior Midwives and less than one third of the staff reported that the basis for this policy was research. KEY CONCLUSIONS: Units with a written policy are in the minority and small units are far less likely to have such a policy. Wide variation exists in policy, practice and rationale. Diversity within and between units creates anxiety and disillusionment for practitioners. It may also cause confusion for patients who are exposed to different cord-care practices either as these change over time or because they use different units. IMPLICATIONS FOR PRACTICE: The midwifery profession must examine this area of practice and determine how to address this lack of evidence. Further research is required to determine the most effective method of cord care and how best to put the findings into practice. Outstanding questions which beg further investigation are: How do cords heal and separate and what bacteria are naturally involved in this process? What constitutes an infected cord as opposed to a colonised cord?

Clinical Competence↗
PubMed2002

The cultural and social meanings of childbearing for Chinese and Scottish women in Scotland.

OBJECTIVE: to analyse the meanings that women gave to their childbearing experiences in order to provide some useful insights as to how their experiences might be improved. SETTING: maternity units in Scotland. DESIGN: four semi-structured interviews with each of ten Chinese and ten Scottish women in their own language; and unstructured interviews with 45 health workers, women's relatives and their friends. FINDINGS: having children was meaningful to Scottish and Chinese women in Scotland in different ways which were related to their social positions, beliefs and practices involved and the change in social status on the birth of a child. Different meanings demanded different coping strategies in healthy childbearing. Scottish women took greater interest in their sense of control over their childbearing. Some Chinese women were experiencing more extensive cultural conflicts and changes as they tried to identify with the new culture, while the others were experiencing gradual changes over a period of time consciously or unconsciously. Both Chinese and Scottish women in the study were in a struggle between autonomy and control over their childbearing--between the mind and the body. CONCLUSION: childbearing is socially shaped and culturally specific. Maternity services need to consider ways in which cultural sensitive care can be provided to women in a multi-ethnic modern society.

Attitude to Health↗
PubMed1997

Batten disease in the west of Scotland 1974-1995 including five cases of the juvenile form with granular osmiophilic deposits.

We report on 12 children with neuronal ceroid lipofuscinosis (NCL) diagnosed between 1974-1995 in the West of Scotland. Diagnosis was made on the basis of clinical, electrophysiological, radiological and pathological examination including electron microscopy (EM) in all cases. Incidence was calculated on the basis of the year of diagnosis and the live birth rate. Six cases were infantile and 6 juvenile NCL derived from a total of 10 families. No cases of late infantile or early juvenile NCL were identified. All cases were typical in clinical description. Cumulative incidence was 1.61/100,000 live births (0.87 and 0.73/100,000 live births for juvenile and infantile NCL respectively). There was significant delay in diagnosis of the juvenile form of NCL. EM findings were unusual in the juvenile group in that 5 of 6 cases exhibited granular osmiophilic deposits (GROD) rather than typical fingerprint inclusion bodies. Four of these 5 cases also failed to show vacuolation of lymphocytes. Thus, in the West of Scotland, the distribution of NCL cases by type and by EM findings is unusual, and suggests a distinct genetic variant of juvenile NCL, possibly allelic to infantile NCL.

Age of Onset↗
PubMed2002

Gay men's HIV testing behaviour in Scotland.

This paper reports on the social and demographic factors associated with HIV testing in gay men in Scotland. Trained sessional research staff administered a short self-complete questionnaire to men in gay bars during January and February 1999 in Glasgow and Edinburgh, Scotland. Questionnaires were completed by 2,498 men (response rate of 77.5%). Half (1,190; 50%) reported ever having been HIV antibody tested, with men in Edinburgh more likely to report testing. Testing was associated with being older (26 years plus), higher education, reporting one unprotected anal intercourse (UAI) partner, or six or more UAI partners, in the last year, genitourinary medicine clinic service use, and lifetime experience of sexually transmitted infections. There was no relationship between HIV testing and treatment optimism, or evidence of a "post-Vancouver" effect. Over a fifth of men who said that they knew their own HIV status at last UAI had never been tested. Current testing policy needs to be challenged if there is to be an increase in the number of gay men who know their HIV status and, if tested HIV-positive, to then access antiretroviral treatments.

Adolescent↗
PubMed2003

The application of a facet scale job satisfaction model for environmental health officers in Australia and Scotland.

The direction provided from published research emphasises that job satisfaction is multi-dimensional, and the associations with work related and non-work related predictor variables as being complex. The isolation of the discrete influence of individual predictor variables is therefore difficult. The application of multivariate analysis incorporating hierarchical stepdown protocols and interaction effects offers one approach that provides for the discrimination between the explanatory characteristics of these variables. Principal Axis Factoring with oblimin rotation and Structural Equations Modelling were applied to survey data to develop a Measurement Model comprising six latent constructs that characterised the job satisfaction of Environmental Health Officers (EHOs) in Australia. The model was successfully applied to data from the EHOs in Scotland. This paper presents the application of the Measurement Model to examine the association between selected work content and the demographic aspects of the EHOs in Australia and in Scotland, and their job satisfaction. The analysis protocol included Canonical Correlation, Multiple Linear Regression and Factorial Manova and Mancova. The unique variance explained by the work content factors and the demographic aspects of the job were similar. The linear representation of model pathways provided more comprehensive explanatory power than the curvilinear association. The presentation of evidence of multidimensional complexity, including interaction effects, underscored the need for caution before generalising on the influence of individual factors on job satisfaction. The analysis protocol presented in this paper can be applied to other situations in environmental health involving multivariate complexity.

Australia↗
PubMedDate not supplied

Audit, guidelines and standards: clinical governance for hip fracture care in Scotland.

PURPOSE: To report on experience of national-level audit, guidelines and standards for hip fracture care in Scotland. METHODS: Scottish Hip Fracture Audit (from 1993) documents case-mix, process and outcomes of hip fracture care in Scotland. Evidence-based national guidelines on hip fracture care are available (1997, updated 2002). Hip fracture serves as a tracer condition by the health quality assurance authority for its work on older people, which reported in 2004. RESULTS: Audit data are used locally to document care and support and monitor service developments. Synergy between the guidelines and the audit provides a means of improving care locally and monitoring care nationally. External review by the quality assurance body shows to what extent guideline-based standards relating to A&E care, pre-operative delay, multidisciplinary care and audit participation are met. CONCLUSION: Three national-level initiatives on hip fracture care have delivered: Reliable and large-scale comparative information on case-mix, care and outcomes; evidence-based recommendations on care; and nationally accountable standards inspected and reported by the national health quality assurance authority. These developments are linked and synergistic, and enjoy both clinical and managerial support. They provide an evolving framework for clinical governance, with casemix-adjusted outcome assessment for hip fracture care as a next step.

Diagnosis-Related Groups↗
PubMed2000

Chemical lumbar sympathectomy revisited: survey of the current practice of vascular surgeons in Scotland.

OBJECTIVE: To investigate the current practice of chemical lumbar sympathectomy by vascular surgeons in Scotland. DESIGN AND SUBJECTS: Postal questionnaire survey of all practising vascular surgeons in Scotland (n = 40) identified from the list of members of the Vascular Society of Great Britain and Ireland. RESULTS: Most surgeons (30 of the 34 respondents, 88%) practise chemical lumbar sympathectomy. Their main indications are in line with current recommendations in relevant publications. Controversial areas include its use as an adjunct to operation and in treating diabetic feet. The procedure is done by vascular surgeons (16 of 34 respondents, 47%) and anaesthetists or radiologists (14 of the 34 respondents, 41%). There is a wide variation in the technical aspects of the procedure. All respondents make a clinical assessment of outcome. CONCLUSION: The role of chemical lumbar sympathectomy is likely to remain controversial because of the lack of a valid prognostic marker, technical variability, and the fact that it is often used in elderly patients.

Aged↗
PubMed2004

The impact of meningococcal serogroup C conjugate vaccine in Scotland.

The increasing number of cases of serogroup C meningococcal disease in Scotland in the late 1990s coincided with the availability of a new meningococcal conjugate serogroup C (MCC) vaccine that, from 1999 onwards, was offered to all individuals aged <20 years. Annual incidence rates between 1994 and 2003 were calculated in 3 age groups (<5 years old; 5-19 years old; and >or=20 years old), and Poisson regression models were used to verify disease trends over time. Dramatic reductions (P<.05) in the incidence of serogroup C meningococcal disease were seen in target age groups: from 15.8 incidents per 100,000 subjects in 1999 (95% confidence interval [CI], 11.3-20.3) to 0.7 incidents per 100,000 subjects in 2001 (95% CI, -0.3 to 1.6), for subjects <5 years old, and from 6.7 incidents per 100,000 subjects in 1999 (95% CI, 5.1-8.3) to 1.5 incidents per 100,000 subjects in 2001 (95% CI, 0.7-2.3), for subjects 5-19 years old. An increasing incidence of serogroup B meningococcal disease in individuals 5-19 years old was clearly established before the campaign began. A 30% decrease in the case-fatality rate for individuals <20 years old was not significant (P=.1598). The MCC vaccine program has been highly effective in Scotland, leading to substantial reductions in serogroup C meningococcal disease and meningococcal mortality, with no adverse effects on other groups.

Adolescent↗
PubMed2004

Oral history, subjectivity, and environmental reality: occupational health histories in twentieth-century Scotland.

This essay uses oral histories of dust disease in twentieth-century Scotland to illustrate the ways in which such history can illuminate how the working environment and work cultures affect workers' bodies and how workers come to terms with the ill-health caused by their employment. It emphasizes the agency of the interpreter but argues further that oral histories of dust disease in twentieth-century Scotland are simultaneously influenced by, and evidence for, material conditions. The essay explores the notion that the bodies, not just the voices of interviewees, are material testament to health-corroding work practices, cultures, and habitat. The focus is the problems caused by the inhalation of coal and asbestos dust.

Historiography↗
PubMed1997

Death certification in treated cases of presenile Alzheimer's disease and vascular dementia in Scotland.

INTRODUCTION: although death certification data are commonly used in dementia epidemiology, their reliability has been questioned. METHODS: death certificates were available from the Registrar General for Scotland for all patients with Alzheimer's disease/presenile dementia (AD PSD) or vascular dementia (VaD) who had died in Scotland up until 31 December 1994. Primary (immediate and underlying) and contributory causes of death were noted as well as place of death. Occupations of male patients were obtained from death certificates or from case notes and classified according to the Standard Occupational Classification. Bronchopneumonia was considered a non-specific cause of death and specific causes of death were classified as: cardiac disease, dementia, cerebrovascular disease, neoplasms, other vascular diseases and other diseases. Place of death was recorded as psychiatric hospital, district general hospital, nursing home or private residence. RESULTS: death certificates of 398 people who had been treated for AD PSD and 348 who had been treated for VaD were identified. Bronchopneumonia was the most common immediate cause of death in the AD PSD group (70.9%) but less so for the VaD group (51.7%). For both groups place of death was associated with significant differences in pneumonia being reported as the immediate cause of death as well as specific underlying and contributory causes of death. Dementia was recorded for 90.5% of AD PSD patients but for only 49.7% of the VaD group. CONCLUSIONS: Scottish death certificate data significantly underestimate the prevalence of presenile VaD. Changes in patterns of institutional care may affect dementia rates estimated from death certificate data.

Aged↗
PubMed2003

Gender, age and deprivation differences in the primary care management of hypertension in Scotland: a cross-sectional database study.

BACKGROUND: Little is known about the community management of cardiovascular disease among different gender, age or deprivation groups, even though much of the long-term treatment takes place within primary care. OBJECTIVES: Our aim was to determine whether important gender, age and deprivation differences exist in the primary care management of hypertension. METHODS: A cross-sectional analysis of computerized general practice data was carried out in 43 practices in Scotland contributing to the Continuous Morbidity Recording project. The main outcome measures were odds ratios of being under GP review; receiving different classes of antihypertensive treatments [thiazides, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, calcium channel blockers]; and receiving other cardiovascular preventative treatments (statins and/or antiplatelets). RESULTS: Compared with males, female hypertensive patients were more likely to receive a thiazide and less likely to be given an ACE inhibitor, calcium channel blocker or secondary preventative treatment. Elderly hypertensive patients were less likely than the youngest patients to be under GP active review, more likely to be on a thiazide, calcium channel blocker or antiplatelet treatment, and less likely to be on a statin. More deprived hypertensive patients were less likely to be under GP review, or to be on a thiazide or a statin, but were more likely to be on a calcium channel blocker or an antiplatelet drug than the most affluent group. CONCLUSIONS: Important gender, age and deprivation differences exist in three important components of the primary care treatment of hypertension in Scotland.

Adult↗
PubMed2005

The prevalence of ear, nose and throat problems in the community: results from a national cross-sectional postal survey in Scotland.

OBJECTIVE: To assess the prevalence of ear, nose and throat (ENT) symptoms experienced by individuals living in Scotland, and their use of GP or hospital services for these problems. METHODS: A cross-sectional postal self-completed questionnaire was sent to a random sample of 12,100 households throughout Scotland. 15,788 individuals aged 14+ years living in the 7244 households who returned the questionnaire (adjusted response rate 64.2%) participated in the study. RESULTS: Roughly a fifth of respondents reported currently having hearing difficulties, including difficulty following conversations when there is background noise and hearing problems causing worry or upset; few wore a hearing aid regularly. A fifth reported noises in head or ears (tinnitus) lasting more than five minutes. In the previous year, between 13 and 18% of respondents reported persistent nasal symptoms or hayfever, 7% sneezing or voice problems and 31% had at least one episode of severe sore throat or tonsillitis. Nearly 21% of all respondents reported ever having had dizziness in which things seemed to spin around the individual; 29% unsteadiness, light-headedness or feeling faint; 13% dizziness in which the respondent seemed to move. Important gender, age, occupation and deprivation differences existed in the occurrence of these ENT symptoms. There was considerable variation in the proportion of individuals consulting their GP or being referred to hospital for different problems. CONCLUSIONS: ENT problems occur frequently in the community, and most are managed without consulting medical services. Whilst reasonable for many problems, there are likely to be important groups in the community with ENT problems that might benefit from modern interventions.

Adolescent↗
PubMed2006

An evaluation of the Health Promoting Health Service Framework: the implementation of a settings based approach within the NHS in Scotland.

In 1996 the Health Education Board for Scotland (now NHS Health Scotland) began a process of developing a 'settings'-based framework that would inform health promotion work across Scottish health services--the Health Promoting Health Service Framework (HPHS). It took the form of a flexible guidance document, attending to the foundations of integrated and sustainable health promotion practice via specific areas like partnership work, policy development and staff health. The project has subsequently been progressed over an extended period, comprising three phases: an initial development of the resource; piloting of the framework; and a wider assessment of implementation and initial impact. This paper reports on the latter phase. Within the context of various issues pertaining to the evaluation of a 'settings' approach and based on the use of case study methodology in nine HPHS pilot sites, this paper reports on the latter 2 year phase. This involved ongoing concern for understanding intervention processes and a growing interest in intervention outcomes and the paper reports on findings in each of these domains. In relation to outcomes, some positive gains in various indicators were detected though significant problems were experienced in this aspect. More significantly, the work was able to gain insights into what we call 'necessary conditions' of implementation. We theorize a range of 'contextual' factors (e.g. responsiveness to health improvement policy agendas) and project specific 'mechanisms' (e.g. providing skilled support) and present these as a nexus of conditions required for effective implementation of health promotion practice within explanatory models. Most significantly, we stress the relative frailty of any settings implementation strategy based simply on the uncoordinated dissemination of a tool or resource.

Community Networks↗
PubMed1997

Endometrial assessment procedures: an audit of current practice in Scotland.

The objective was to determine, in relation to endometrial assessment procedures, the extent to which the current practice of gynaecologists in Scotland (as assessed both by questionnaire survey of clinicians and review of hospital records) accords with recommendations in recent evidence-based guidelines. All 132 consultant gynaecologists in Scotland were surveyed and 123 (93%) responded. In addition, the case records of 1199 consecutive women undergoing endometrial assessment procedures in 12 representative hospitals were reviewed. Over two thirds of consultants agreed that endometrial assessment procedures are seldom indicated in women aged under 40 years and over 80% agreed that when such procedures are indicated, outpatient endometrial biopsy represents the method of choice. However, the review of case records showed that 23% of the women who underwent endometrial assessment were aged under 40 years and only 44% of the procedures undertaken were out-patient endometrial biopsies. We conclude that some Scottish women may be undergoing endometrial assessment procedures unnecessarily and that, in some centres, traditional dilatation and curettage is being replaced by hysteroscopy under general anaesthetic in theatre although there is no evidence that this procedure provides more clinically useful information than out-patient endometrial biopsy.

Adult↗
PubMed1996

Population risk factors for hospitalization for stroke in Scotland.

BACKGROUND: There is considerable heterogeneity of cerebrovascular disease (CVD) incidence throughout Scotland. We sought to relate this geographical variation to differences in population risk factors. METHOD: A computer search of linked national hospital discharge data was performed. Individuals were selected if they had been coded with a diagnosis of CVD (ICD-9 430-438), 1984-1986. Age-sex specific rates were correlated to deprivation score and estimated population risk factors for the 22 local government districts of the Scottish Heart Health Study (1984-1986). RESULTS: Men were more commonly admitted in all districts except one, with an overall male:female ratio of 1.43 (P < 0.0001). Rates for men were significantly higher in populations with elevated mean diastolic blood pressure, greater mean alcohol consumption, and where fewer men ate fruit. The most significant associations of male CVD hospital admissions were with population density and deprivation. A similar pattern was found for women, where CVD was significantly associated with elevated diastolic blood pressure, more smokers and fewer non-smokers, and fewer eating fruit. Again rates were higher in densely populated, deprived districts. Multiple linear regression identified the proportion for men. Sex difference was explained by vitamin C intake. CONCLUSION: Geographical variation in CVD rates in Scotland is related to identifiable population risk factors for atherosclerosis and urban environment.

Adult↗